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ICD-10-PCS: Fogarty Catheters Require a Different Approach

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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About the Author

Lynn Kuehn is president of Kuehn Consulting, LLC, a consulting firm specializing in coding for all settings and physician practice management issues. Lynn is a nationally recognized trainer on ICD-10-PCS and other HIM-related topics. Lynn served on the AHIMA Board of Directors and authored several of AHIMA’s most popular books including Procedural Coding and Reimbursement for Physician Services, CCS-P Exam Preparation, and ICD-10-PCS: An Applied Approach.

One thought on “ICD-10-PCS: Fogarty Catheters Require a Different Approach

  1. Vanessa Rogers - June 28, 2018 at 6:03 pm

    Hello! Just wanted let you know that I listened today on your one-hour webinar on ICD-10-PCS Vascular Coding. You did a phenomenal job!

    I had the pleasure of meeting you in a training session provided by my job, Kaleida Health. it was just before ICD-10 rolled out and we received the draft copies of the books.

    You’re such an excellent speaker and trainer!