Radiology Coding Alert

See how the correct choice hinges on your knowledge of anatomy and terminology.

When it comes to imaging involving catheter placements, you may typically be used to confirmation of placement through either fluoroscopic imaging guidance during the procedure or afterward via an independent X-ray. When all goes according to plan with these procedures, the diagnosis coding is relatively straightforward.

The same can’t be said for clinical encounters involving complications to catheter placements. Whether it’s through a vessel, the urinary tract, or otherwise, there’s a lot that can go wrong during the fitting and placement of a respective catheter.

Test out your skills on catheter complication coding using the following two examples.

Consider ICD-10-CM’s Choice of Catheter Complication Terminology

Example: A chest X-ray for a patient experiencing pain post placement of a chemotherapy infusion catheter reveals that the tip of the catheter has broken off.

This question presents a slight challenge unless you’re fluent with chemotherapy infusion catheterizations. In the case of chemotherapy, a provider may administer chemotherapy via a variety of methods including intravenous (IV), intra-arterial, intracavitary, orally, and even topically. In this example, the report may not indicate whether the infusion was IV or intra-arterial, but the coding for the breakdown of either type of catheter remains the same. However, there remains at least one potential pitfall along the way that could put a wrench in your coding.

There’s more than one route within the ICD-10-CM Alphabetic Index to the correct code, but a practical starting point is “Complication(s) (from) (of)” since the diagnosis is the direct result of a procedure. From there, you’ll find the subterm catheter (device), but you’ll only encounter a coding option for intravenous infusion. Since you technically don’t yet know that the correct code covers both IV and intra-arterial infusions, your only next step is to either search for a secondary route or get clarification from the radiologist as to the type of chemotherapy infusion that resulted in the catheter breakdown.

Fortunately, an alternative route will yield a working answer, but you’ve got to be familiar with the correct set of terminology to use in your search. For the sake of ICD-10-CM purposes, you’ll refer to the breaking off of the tip of a catheter following any sort of catheterization procedure as a “mechanical breakdown.”

Note: There are some instances where you’ve simply got to be fluent with the way the ICD-10-CM code book chooses to define various clinical situations. While a catheter breaking off inside a vessel will rarely be referred to as a “mechanical breakdown” in a dictation report, it’s on the coder to understand when the ICD-10-CM code book allows for the use of synonymous terminology, such as in this case.

With this in mind, you’ll find your answer by searching for Breakdown ? device, graft or implant ? catheter NEC ? infusion NEC ? T82.514A (Breakdown (mechanical) of infusion catheter, initial encounter). There are a few additional subterms underneath “infusion NEC,” but none align with the diagnostic criteria you’re looking for. You’ll also see that T82.514A is the same code that your first search for an IV catheter infusion mechanical breakdown yielded.

Discern Between Breakdown, Displacement Terms

Example: The impression of a pelvic X-ray reveals a dislodged Foley catheter used for dialysis treatment.

Using what you’ve learned in the previous example, you might assume you’ve got the perfect start within the Alphabetic Index. However, you’ve got to make sure you avoid not one, but two fatal mistakes along the way.

In reference to that “Note” above, you might assume that a dislodged catheter meets the same criteria as a “breakdown” of a catheter, but not so fast. The ICD-10-CM book considers a fractured (or broken) catheter to qualify as 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.

But even with this knowledge on hand, you’re not out of the woods yet. Before going any further within the index, you should take a moment to understand the difference 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 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 subterms “urethral indwelling” and “urinary NEC” present themselves. 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 subterm “urethral indwelling” when you see it listed as an Alphabetic Index subterm.

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