Cardiology Coding Alert

Question: For a patient with end stage renal disease, what is the appropriate ICD-9 code for thrombosis of AV dialysis fistula?

Oregon Subscriber

Answer: You should use 996.73 (Other complications of internal [biological] [synthetic] prosthetic device, implant and graft; due to renal dialysis device, implant and graft) as the first-listed code to describe a malfunctioning dialysis shunt.

Watch for: ICD-9 2010 includes a rule to use an additional code to identify the complication, "such as venous embolism and thrombosis (453.2-453.9)." ICD-9 conventions state that the "use additional code" instruction means you should use an additional code -- if the information is available -- to provide a more complete picture.

Some payers may want you to add a code for the chronic renal failure, as well. In the case of a patient with end stage renal disease, you'd use 585.6 (End stage renal disease).

Definitions: Thrombosis refers to blood clot (or thrombus) formation obstructing blood flow. The AV (arteriovenous) fistula is a surgically created communication between an artery and a vein to facilitate chronic hemodialysis.