Home Health ICD-9/ICD-10 Alert

Question: For a patient with end stage renal disease,what is the appropriate ICD-9 code for thrombosis of AV dialysis fistula?

Answer: You should use 996.73 (Other complications of internal [biological] [synthetic] prosthetic device, implant and graft; due to renal dialysis device, implant and graft) as the first-listed code to describe a malfunctioning dialysis shunt.

Watch for: ICD-9 2010 includes a rule to use an additional code to identify the complication, "such as venous embolism and thrombosis (453.2-453.9)." ICD-9 conventions state that the "use additional code" instruction means you should use an additional code -- if the information is available -- to provide a more complete and accurate picture.

You'll also need to add a code for the chronic renal failure. In the case of a patient with end stage renal disease, you'd use 585.6 (End stage renal disease).

Definitions: Thrombosis refers to blood clot (or thrombus) formation obstructing blood flow. The AV (arteriovenous) fistula is a surgically created communication between an artery and a vein to facilitate chronic hemodialysis

Warning: The routine care of a dialysis catheter is not covered under the home health benefit. But the care of an abandoned dialysis catheter is. The V56 (Encounter for dialysis and dialysis catheter care) codes indicate routine care of dialysis catheters. While the codes 996.73 (Other complications of internal [biological] [synthetic] prosthetic device, implant and graft; due to renal dialysis device, implant and graft) as well as 996.62 (Infection and inflammatory reaction due to vascular device, implant, and graft) and 996.68 (Infection and inflammatory reaction due to peritoneal dialysis catheter) can be used to indicate the abandoned catheter.