ICD-10 coding challenge: IVC filter complication

Feb. 29, 2016 / By Sue Belley, RHIA

CHALLENGE QUESTION

A 62-year old female presented to the Emergency Room with a chief complaint of chest pain. During workup, the patient was found to have non-sustained runs of ventricular tachycardia. A cardiac catheterization done several months prior had shown minimal coronary artery disease. The patient was admitted to the Coronary Care Unit for further evaluation and treatment. Two years prior to admission, the patient had an IVC filter placed prophylactically before undergoing a total knee arthroplasty based on her history of deep vein thrombosis of the lower extremity with pulmonary embolism A CT scan of the abdomen was performed which identified that one of the wire centering legs of the IVC filter was missing. It was determined that it had fractured and migrated to the right ventricle. The patient was taken to the Interventional Radiology suite where the wire was carefully removed from the right ventricle by catheter using a catheter with snare via percutaneous approach.

Assign the appropriate ICD-10-CM and ICD-10-PCS codes for this scenario.

Diagnosis Codes

T82.515A  Breakdown (mechanical) of umbrella device, initial encounter

I47.2           Ventricular tachycardia

I25.10           Atherosclerotic heart disease of native coronary artery without angina pectoris

Z86.711       Personal history of pulmonary embolism

Z86.718       Personal history of other venous thrombosis and embolism

Procedure Codes

02CK3ZZ     Extirpation of matter from right ventricle, percutaneous approach

BLOG

Our February coding challenge focuses on complications with IVC filters.  Reports of adverse events and product problems associated with IVC filters have surfaced in the past few years and have even been reported in the news. The adverse event reports include device fracture, migration, and embolization, perforation of the inferior vena cava or other internal organs and difficulty removing the device. In this situation, the specificity of ICD-10-CM provides physicians, medical researchers and patient quality and safety experts with aggregate data about adverse events associated with IVC filters. In ICD-9-CM, the most specific code that could be assigned for a mechanical breakdown of an IVC filter like the one the patient in this scenario experienced was 996.1, Mechanical complication of vascular device. The ICD-9 code was not able to tell the researcher, for example, which vascular device sustained a mechanical complication – actual chart review would be necessary to get to the level of granularity needed – in this case, the specific device involved. ICD-10-CM is able to identify the specific device with code T82.515A, Breakdown (mechanical) of umbrella device. In addition, ICD-10-CM has specific codes for displacement, leakage and other mechanical complications of IVC filters.

So, it’s true . . . ICD-10 can better help in the effort to improve patient quality and safety by providing more granular information to those who need it.

Sue Belley is a project manager with the consulting services business of 3M Health Information Systems.

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