The patient has a malfunctioning right internal jugular tunneled catheter. At surgery, the old catheter was removed and a new one placed. Under ultrasound guidance, the jugular was cannulated; the cuff of the old catheter was dissected out; and the entire catheter removed. An incision was then made at the entry site; a new catheter was tunneled through the subcutaneous tissue from the chest wall up into the neck. The guidewire and dilator were removed leaving the peel-away introducer in place. The catheter was threaded through the peel-away and the catheter was placed. Fluoroscopy confirmed that the catheter tip was in the right atrium. The port was aspirated, flushed and capped with heparin. The incision at the base of the neck was sutured. What are the appropriate ICD-10-PCS codes for the removal and insertion of an internal jugular tunneled catheter?
The internal jugular tunneled catheter consists of two-parts, an infusion port and catheter. Code the insertion, as well as the removal of both the infusion device and the vascular access device. Assign the following ICD-10-PCS codes:
02PY33Z Removal of infusion device from great vessel, percutaneous approach, for removal of the infusion portion of the catheter
0JPT0XZ Removal of vascular access device from trunk subcutaneous tissue and fascia, open approach, for removal of the port
02H633Z Insertion of infusion device into right atrium, percutaneous approach, for insertion of catheter
0JH63XZ Insertion of vascular access device into chest subcutaneous tissue and fascia, percutaneous approach, for insertion of the vascular access portion of the device
In this case, there was a lot of tissue surrounding the cuff of the old catheter, which needed to be dissected and cut, in order to remove the catheter. A new catheter was then tunneled through the subcutaneous tissue. Therefore, in this instance, the removal of the catheter is coded as an open approach.