How to code Central Venous Catheter Complications codes

Central Venous Catheter complications ICD 9 codes

Central Venous Catheter Complications codes Definitions: An infection due to the presence of a central venous catheter, vascular device, implant or graft. This infection leads to Central Venous Catheter complications. The infection can range from sepsis to a localized infection.
Local infections may occur at catheter exit or insertion sites, port or reservoir locations, or tunnel infections. Signs of a localized infection may include purulent discharge, and localized pain, erythema, or tenderness. Following are the infection for Central Venous Catheter complications codes.

996.62 Infection due to other vascular device, implant, and graft
999.31 Other and unspecified Infection due to central venous catheter
999.32 Bloodstream infection due to central venous catheter
999.33 Local infection due to central venous catheter

Central line blood stream infections (CLABSI), are being defined by the Centers for Disease Control and Prevention, as laboratory confirmed bloodstream infections (LCBI) that are not secondary to an infection at another site.

LCBI must meet one of the following criteria:

Patient has recognized pathogen cultured from one or more blood cultures; and the organism is not related to an infection at another site.
Patient has at least one of the following signs or symptoms; fever (>38 C, chills, or hypotension AND; signs and symptoms and positive laboratory results are not related to an infection at another site AND; common commensal organism is cultured from two or more blood cultures drawn on separate occasions.

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 Patient < year of age has at least one of the following signs or symptoms; fever (38 C core) hypothermia (<36C core), apnea, or bradycardia AND; signs and symptoms and positive laboratory results are not related to an infection at another site AND; common commensal organism is cultured from two or more blood cultures drown on separate occasions.

Central venous catheters: A central line or central venous catheter (CVC) is a long, thin, tube placed into the large veins of the neck, chest or groin (e.g., jugular, subclavian, femoral or peripheral cephalic, basilica and umbilical). The CVC may be threaded through the superior vena cava directly into the heart, or through the heart and into the inferior vena cava or other central vascular location. It is not the type of device that determines if a line qualifies as a central line. The line tip must terminate in one of these vessels to qualify as a central line (aorta, pulmonary artery, superior vena cava, inferior vena cava, inferior vena cava, brachiocephalic veins, internal jugular veins, subclavian veins, external iliac veins, common iliac veins, femoral veins, and in neonates, the umbilical artery/vein). Central Venous Catheters are often use for intensive services such as cardiovascular monitoring, long term access for intravenous infusion of antibiotics, blood & blood products, TPN, cytotoxic therapy, or fluid status monitoring. Pacemaker wires, Extracorporeal membrane oxygenation, femoral arterial catheters, and intraaortic balloon pump devices and other non-lumened devices are not considered central lines. Peripheral venous catheters & other vascular devices, implants & grafts: A peripheral line or vascular access catheter is a short, thin tube placed in the peripheral (smaller) vessels of the extremities, usually the arm or hand.It is used for infusion of fluids, medications, or blood products & sampling or dialysis. Non-coronary arterial grafts, arteriovenous fistulas or shunts, and infusion pumps are other implanted vascular devices used for therapeutic treatments.

Documentaion required for Central Venous Catheter complications.

Patients may develop signs & symptoms of infection following the insertion of catheter, pump or graft such as fever which can be low-grade or intermittent elevated white count, localized site redness, hypotension, tachycardia, that is not attributed to another source.
Clinicians will do a general work up as to the cause of the infection and by process of elimination; removal and/or culture of device may determine it to be device related. Lab tests of blood and urine, cultures of blood and urine and the tip of the catheter or other vascular device may be done.
Bacteria may be found on a culture of the vascular tip of a catheter after removal and positive blood cultures for the same organism. Staph Epidermidis, Staph Aureus, and C. Albicans are the most common but vary in their virulence to cause a systemic infection. Positive blood cultures are not always present but clinicians may still suspect and treat the patient as if they do have a vascular device related infection.

Associated diagnosis with Central Venous Catheter complications

Sepsis, septicemia, bacteremia, endocarditis, cellulitis, abscess, & thrombophlebitis.
Therapies: Medications: Antibiotics specific to the type of bacteria suspected and its sensitivities, such as vancomycin; linezolid, diflucan, flagyl, and clindamycin.
Non-Surgical Therapies: Removal of the suspected device and possible re-insertion of another in different site if therapy is still needed.

Coding issues with Vascular catheter associated Infections

There must be documentation of a link between the infection and the vascular catheter or device to use the complication code, such as line sepsis or cellulitis due to AV graft. If unclear query the physician for clarification.

When the reason for an admission is linked to a complication of medical or surgical care, the complication code is listed as the principal diagnosis, with an additional code to identify the specific infection (e.g., Cellulitis, Sepsis, Septicemia, etc.).

In the case where the source of infection is self-inflicted through tampering or noncompliance, assign code 999.31, Other and Unspecified Infection Due to Central Venous Catheter and then code the patient’s medical condition.

Code also V15.81, Noncompliance with Medical Treatment, and E988.8, Injury by Other and Unspecified Means,

Code 999.31-999.33 specifically identifies central line-associated infections. Code 996.62 identifies infections and inflammatory reactions due to arterial vascular catheters and non-coronary arterial grafts, venous peripheral catheters and peripheral dialysis catheters.

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