# VADs



## cscott2496 (Apr 16, 2008)

I am trying to find out the correct diagnosis code to use for an insertions of vascular access devices.  In Faye Brown it states to code to the malignancy or diagnosis that the patient is receiving treatment for and not the V58.81 code.  But this pertained to in-patient status.  Would the same rule apply to out-patient status for the insertion of VADs?  Again, this is for a new insertion of a VAD and not a replacement or removal.

Thanks!


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## mbort (Apr 16, 2008)

I code the reason for the VAD, which is generally the malignancy.  I've never had any problems with this methodology for outpatient procedures.


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## kevbshields (Apr 16, 2008)

Where in the text does Faye Brown mention coding the reason above the V58 code?  I'd like to review that.

Thanks!


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## cscott2496 (Apr 16, 2008)

In the 3M module under Faye Brown referecences.  Go to the search menu and then type in VAD.  It is under 24-Diseases of the Circulatory System, pgs. 282-283.

If anyone can find documentation of other dx. coding to substantiate this for out patient coding, I would appreciate the info.

Thanks!


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## kevbshields (Apr 16, 2008)

After reviewing Chapt 24's references to VAD, I'm afraid I just cannot locate an area where the text speaks of using the indication for the procedure over the encounter reason as the Primary ICD Dx.  

I do see where Faye spoke of the purpose of the catheters, but not anywhere that the V58 section is referenced, nor an area where the use of that section would be discouraged as the Primary Dx.  

I'd check _Coding Clinic_ for references on that V58 section and catheter insertion encounters.

As for inpatient vs outpatient coding, keep in mind that during the IP encounter (DRG), it is not necessary link procedures and diagnoses; there is no such concept in IP coding.


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## cscott2496 (Apr 16, 2008)

I will cut and paste the text I am referring to when I return to work tomorrow.  But if you review the text in the ICD-9 for the V58.81, it states that this code is used for replacement or removal of the VAD.  I actually went further into reviewing the code and the reason this particular code was added was due to the fact that coders and billers complained that there was not a more specific code for exchanging or removing a VAD.  So I am assuming that prior to the addition of this V code, that the condition was coded.  I did look in the coding clinics but again, could not find specific documentation on this subject.  Thanks for the replies and your help!


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