AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2016 Issue 3; Ask the Editor
Insertion of Arteriovenous Graft Using HeRO Device
A 49-year-old patient on hemodialysis for end-stage renal disease presented with central vein stenosis and was taken to the operating room for creation of a left arm arteriovenous graft with a HeRO device, via the left internal jugular vein. An existing left internal jugular vein catheter was transected then used to pass a guide wire down into the inferior vena cava. The sheath with the stent graft was advanced into the superior vena cava atrial junction, then tunneled into the deltopectoral groove. An incision was made in the antecubital fossa, and the brachial artery was dissected. A graft was tunneled between the stent and the deltopectoral groove incision down to the antecubital incision. The graft was anastomosed to the brachial artery. The proximal portion was anastomosed to the graft that comes with the HeRO device. Then the connector piece was used to connect the stent graft on to the connector. What is the correct code assignment for creation of the AV graft using HeRO device via the left internal jugular vein? ...
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Article Overview
This article explains a vascular access case involving a HeRO device used to establish hemodialysis access through the upper extremity and central venous system. It is intended for medical coders, CDI staff, and reimbursement professionals who need to understand how the procedure is described and how the related code assignment question is framed. The discussion centers on the operative approach, device-related components, and the coding considerations raised by the case.
Why This Topic Matters
HeRO-related access procedures can be difficult to interpret from operative notes because they combine graft creation, tunneled components, and central venous work. Understanding the scope of the procedure helps coders evaluate the correct classification of the service.
What You Will Learn
- How a HeRO-based hemodialysis access procedure is described in an operative setting.
- What procedural elements are present in a central venous access and arteriovenous graft creation case.
- Why this type of case may require careful code review in vascular access coding.
- How the article frames the coding question for the procedure.
Who Should Read This
- Medical coders
- Coding auditors
- Clinical documentation integrity specialists
- Revenue cycle professionals
- Vascular surgery coding staff
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