# Insert Port a Cath ICD



## nyckimmie (Jan 25, 2019)

Hello,
I could use some help with an audit/education dispute.
When inserting a port-a-cath (cpt 36561) for chemo, what is the 1st listed dx?  Z45.2 (2ndary code cancer) -or- cancer code (ex. C56.--, no Z code).

Education: Z45.1- Rationale:  see index logic ...Admission for...Fitting (of)...Port-a-cath = Z45.2.  Fitting means installing, putting in, placing.
Auditing:  Cancer code.  Rationale: ICD guideline- Section I.C.21.c.7. "The aftercare Z code should not be used if treatment is directed at a current, acute disease. The diagnosis code is to be used in these cases.".   the catheter is initially being inserted for treatment of the cancer  if the patient had a problem later on with the catheter and it needed to be replaced or when chemo is done and the catheter needs to be removed you would use the Z code because at time the treatment is being directed at the catheter not the cancer.

Thanks for any advice.
Kim


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## thomas7331 (Jan 25, 2019)

I think it can be argued either way - this is one of those situations where there is conflicting direction in ICD-10.  Per guideline Section IV.G, "List first the ICD-10-CM code for the diagnosis, condition, problem, or other reason for encounter/visit shown in the medical record to be chiefly responsible for the services provided."  If you read this to mean that since the Port-a-Cath is the primary reason for the encounter and there is no treatment at this encounter being directed at the cancer, then Z45.2 is correct as a first listed code.  But if your interpretation is that the since the Port-a-Cath is for the purpose of initiating the cancer treatment and therefore the encounter is for treating the cancer, then the cancer should be first listed.  

IMO, this is a very minor technicality (which I'd hope your auditors & educators would understand).  If we had a court for coding, we could argue both sides of the case and let the jury decide who is right, but unfortunately we don't have that.  It's something your leadership should decide one way or the other, or agree to allow both, so that your staff are all on the same page.  I'd point out too, as I often do for coders I'm training or supervising, that the ICD-10 guidelines are just that - they are guidelines and not hard and fast rules and regulations.  As is often said, a coder should choose the code that best represents the services documented.  But there may be different ways to represent documentation in codes, and different people will have different opinions about what is 'best' - those kinds of differences are inevitable.  I've seen these claims coded both ways and have yet to see one deny, and I think that both code sequences quite adequately represent what is going on, so in my mind, if one way is in fact 'wrong', it doesn't rise to the level of being a serious infraction and probably isn't worth investing the time to be disputing - after all, the more we belabor these kinds of questions, the more resources we are draining out of any already overtaxed healthcare system.  OK, sorry, probably more 'advice' than you wanted so I'll get off my soapbox now - maybe I've been coding too long on a Friday!


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## csperoni (Jan 25, 2019)

*We code cancer dx*

We have always coded the cancer diagnosis (unless we are replacing a broken or non-functioning port) and I don't recall ever having an issue.


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## Tammy Hughes (Jan 25, 2019)

We use " poor venous access" I87.2 with a secondary code of what their cancer is. Never had an issue. 
Hope that helps.


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## mjstack (Jan 4, 2023)

1/4/2023 hello, 
 In the above question, I was told in the absence of a cancer code to use I87.1, now I have directions to use I87.2 which is CVI chronic venous insufficiency, which I use in Wound care. Neither code comes up in the list for cross over in AAPC codify. Any advice? ty


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## thomas7331 (Jan 4, 2023)

mjstack said:


> 1/4/2023 hello,
> In the above question, I was told in the absence of a cancer code to use I87.1, now I have directions to use I87.2 which is CVI chronic venous insufficiency, which I use in Wound care. Neither code comes up in the list for cross over in AAPC codify. Any advice? ty


I would disagree with what you've been told here.  You can't default to any diagnosis - you can only use a diagnosis that the provider has documented.  If you don't have one, then you'd need to query the provider.  As per the posts above, the best diagnosis is the one that represents the condition that is being treated that requires the port-a-cath.


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