by Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA
Fogarty catheters are different than other thrombectomy catheters, such as stent retrievers or aspiration catheters. Because of the differences, the approach which must be assigned to code accurately in ICD-10-PCS is also different.
A Fogarty catheter enters the vessel through a cut-down because it contains a guidewire and an inflatable balloon. The guidewire is passed through the clot and the balloon is inflated on the other side of the clot from the entry site. With the balloon still inflated, the balloon is pulled back toward the cut-down opening of the vessel and the clot is extirpated completely. This requires the larger access and exit point that other thrombectomy catheters and makes the approach assignment in ICD-10-PCS the Open approach.
Other thrombectomy catheters, such as the Merci corkscrew retriever or the Trevo stent retriever, enter the body and then the vessel through the use of a guidewire. They are threaded through the vessel to the location of the clot, sometimes the distance of the entire length of the leg or arm. The corkscrew or the stent is then deployed through this catheter into the clot. The clot is incorporated into the corkscrew or the mesh of the stent, is retrieved into the catheter and removed through the body through the puncture site made by the guidewire.
Aspiration catheters, like the Penumbra, work in much the same way. They break up and aspirate the clot into the device and remove it through the same, small access site.
In ICD-10-PCS, stent retrievers and aspiration catheters use an approach assignment of Percutaneous. An Open approach is not necessary for stent retrievers and aspiration catheters, but that doesn’t stop the vascular surgeon from using a cut-down that is already available. The approach is still Percutaneous, even if these catheters enter the body through a cut-down that was created for another device, such as a Fogarty.
ICD-10-PCS Coding of Vascular Procedures
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