ED Coding and Reimbursement Alert

Question: Encounter notes indicate that the physician treated a patient with a "Port-a-Cath malfunction." What exactly is this, and what diagnosis code should I use to represent it?

Nebraska Subscriber

Answer: A physician places a Port-a-Cath just under the skin on the patient's chest, and then inserts the catheter into the superior vena cava. Once the provider inserts the  catheter, he can administer medication or draw blood through it.

(If a patient experiences Port-a-Cath problems, he could certainly end up in the ED, so coders should be aware of this complication.)

The correct diagnosis depends on the type of complication or malfunction, so you will need to return to the encounter form for more info before choosing. Typically, you'll choose a Port-a-Cath complication code from the following options:

• 996.1 -- Mechanical complication of other vascular device, implant, and graft

• 996.62 -- Infection and inflammatory reaction due to internal prosthetic device, implant, and graft; due to other vascular device, implant, and graft (requires an additional code to specify the infection, such as sepsis)

• 996.74 -- Other complications of internal (biological) (synthetic) prosthetic device, implant, and graft; due to other vascular device, implant, and graft

• 999.31 -- Infection due to central venous catheter (requires an additional code to specify the infection, such as sepsis).

E code alert: Once you've chosen the appropriate primary code, you should report E878.8 (Other specified surgical operations or procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at the time of operation) as a secondary code on the claim.