In Coding Clinic, Fourth Quarter 2013, pages 116-117, information was published about the device character for the insertion of a totally implantable central venous access device (port-a-cath). Although we agree with the device value, the approach value is inaccurate. The approach value for placement of a port-a-cath should be “Open.” Furthermore, a port-a-cath is a two-part device, and requires two ICD-10-PCS codes, for the insertions of the catheter as well as the infusion device. We are asking that the Coding Clinic Editorial Advisory Board (EAB) revisit this advice.
Yes, you are correct. In the published example, a subcutaneous pocket was created under direct visualization in order to place the vascular access port, and therefore the approach is “open” for that portion of the procedure. In addition, a totally implantable central venous access device is a two-part device; therefore two ICD-10-PCS codes are required to capture insertion of the device. Assign the following ICD-10-PCS codes for placement of this type of venous access device:
02HV33Z Insertion of infusion device into superior vena cava, percutaneous approach; and
0JH60XZ Insertion of vascular access device into chest subcutaneous tissue and fascia, open approach
This advice is specific to insertion of a totally implantable venous access device, and not for a cutdown to insert a central line. Most central lines are inserted percutaneously without creating a subcutaneous pocket under direct visualization, and so they are not coded with an open approach.