ICD 10 Coding Alert

Use a combination of anatomy and terminology to find the right answer.

Catheter complications can be caused by mechanical issues. If such a complication occurs, radiologists may be brought in to evaluate postsurgical X-rays.

Many times, the complication itself can be resolved by removing and replacing the catheter. However, the coding can be complex. Figuring out the accurate code requires an understanding of anatomy, as well as fluency in navigating between the ICD-10-CM Alphabetic Index and Tabular Index.

Note the ICD-10-CM Terminology for Catheter Complications

Example: A patient is experiencing pain following placement of a hemodialysis catheter. An X-ray examination reveals that the tip of the catheter has broken off.

Coding this case presents a slight challenge unless you’re fluent with hemodialysis catheterizations.

There’s more than one route to the correct code within the ICD-10-CM Alphabetic Index, but a practical starting point is “Complication(s) (from) (of)” since the diagnosis is the direct result of a procedure. From there, you’ll encounter the following sub-terms: catheter (device) ? dialysis (vascular). So long as you’re familiar with the ICD-10-CM code book’s classification of a broken catheter as a “mechanical breakdown,” the rest is smooth sailing. Continuing within the Alphabetic Index, mechanical ? breakdown will land you at code T82.41XA (Breakdown (mechanical) of vascular dialysis catheter, initial encounter).

Distinguish Breakdown Versus Displacement

Example: A pelvic X-ray reveals a dislodged Foley catheter used for a patient with urinary retention.

Using what you’ve learned in the previous example, you might assume you’ve got the perfect start within the Alphabetic Index. However, you must make sure you avoid two major mistakes along the way.

You might initially assume that a dislodged catheter meets the same criteria as a “breakdown” of a catheter, but not so fast. The ICD-10-CM code book considers a fractured (or broken) catheter a “breakdown.” But other terms exist as well. In the case of this second example, a “dislodged” catheter meets the criteria for “displacement.”

Coder’s note: “Catheterization displacements and breakdowns have different consequences and rely on different treatment plans,” says Sheri Poe Bernard, CPC, of Poe Bernard Consulting in Salt Lake City. “Relaying these individual diagnoses accurately is vital to coding, reporting, and outcomes tracking — even when it results in no change in payment,” explains Bernard.

Before going any further within the Alphabetic Index, you should take a moment to understand the differences between a few key terms. “When you see the term ‘infusion,’ as it pertains to catheterizations, you should know that you’re working with catheters inserted into either a large vein or artery,” says Barry Rosenberg, MD, chief of radiology at United Memorial Medical Center in Batavia, New York. That point immediately disqualifies any code documented as an “infusion” for coding of this example.

You should also have a proper understanding of what a Foley catheter is, so you don’t feel inclined to go the route of “urinary NEC,” when sub-terms “urethral indwelling” and “urinary NEC” are present. Consider the Dorland’s Illustrated Medical Dictionary definition of Foley catheter: “An indwelling catheter that has a balloon filled with air or liquid to retain it in place in the bladder”

An indwelling catheter is a catheter inserted into the bladder through the urethra. Keep in mind that this description perfectly aligns with the sub-term “urethral indwelling” when you see it listed as an Alphabetic Index sub-term.

Since “breakdown” won’t be included in the code description for this example, you want to take a different approach to reach the correct code. While there are a variety of routes, stay within “Complication(s) (from) (of)” to get to the final diagnosis code. From that key term, go to catheter (device) ? urethral ? indwelling ? displacement, leading you to T83.021A (Displacement of indwelling urethral catheter, initial encounter).