Anesthesia Coding Alert

Question: What is the appropriate diagnosis code for "difficult IV access"?

Delaware Subscriber

Answer: Some coders report ICD-9 747.69 (Anomalies of other specified sites of peripheral vascular system) for difficult IV access, but other coders shy away from it because its descriptor notes that it includes congenital anomalies (and because "difficult IV access" does not necessarily indicate a peripheral vascular disorder; surgery, radiation, injury or many other things can lead to vascular insufficiency and a difficult IV start).

These coders might recommend 459.81 (Venous [peripheral] insufficiency, unspecified) or 459.89 (Other specified disorders of circulatory system; other) instead, but you're better off not coding the difficult IV access unless the physician specifies the reason. Instead, choose a code based on the reason the patient needs the IV. For example, if the patient is dehydrated, these coders report 276.5 (Volume depletion) instead of a code for poor venous access. Talk to your carrier to determine which way you should report this diagnosis.