Coding, Classification & Reimbursement

1.  External cause code required for thrombosis of dialysis graft?????

Posted 9 days ago
I have been told that external cause codes are required for T82.868A (Thrombosis of cardiac and vascular prosthetic devices, implants and grafts), but I disagree.  Here's a quick synopsis:  Patient has a procedure for a non-transposed basilic vein dialysis graft (stage 1).  While the graft is maturing for stage 2 (superficialization of the graft), it ends up with a thrombosis.  The surgeon performs the same procedure on the opposite arm.
My argument is that there IS NO EXTERNAL CAUSE needed (there was no complication during the original procedure, and the problem is not a result of the original procedure).  This is a common occurrence for dialysis patients who have arteriovenous fistulas.
I would truly appreciate some feedback on this, and am not proud enough that I always have to be right.  I want to be corrected if I am wrong!
Thank you.

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Charissa Becker-Martinez, CCS-P
Certified Coder/Abstractor
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2.  RE: External cause code required for thrombosis of dialysis graft?????

Posted 9 days ago
​Hello!

Based on the information provided, I believe the correct external cause code would be Y83.2 Surgical operation with anastomosis, bypass or graft as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure . Note that assignment of an external cause code does not necessarily mean the complication was an "adverse incident" or a "misadventure".  There are different sets of external cause codes for those occurrences.  A thrombosis of an AVG is a complication of the graft, not the surgery.

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Lawrence Barr
President
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3.  RE: External cause code required for thrombosis of dialysis graft?????

Posted 9 days ago
Hi Lawrence,
Thank you SOOOO much for this information.  I must admit, I DID briefly stumble across the code you mentioned, but it didn't register at the time.  I do not have experience applying external cause codes (outside of my original AHIMA classes - back in 2015), so this has been a good on-the-job learning experience.  I appreciate your feedback and have a better understanding of these external cause codes & their usage.

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Charissa Becker-Martinez, CCS-P
Certified Coder/Abstractor
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4.  RE: External cause code required for thrombosis of dialysis graft?????

Posted 9 days ago
Hello Charissa,

I also agree with Lawrence.  And Christine brought up an important point.  At one of my previous facilities (this was when ICD-9 was still in effect), the directive was that to not report misadventure external causes of injury codes.  They are probably still enforcing it (although the codes are different now) because their rationale may not have changed.  So, I would ensure that you are appropriately reporting misadventure external cause codes for your facility.  Great question!



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Cristina Co
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5.  RE: External cause code required for thrombosis of dialysis graft?????

Posted 9 days ago
​Hi Charissa
I agree with the code given by Lawrence.  However, when you say you are being told the external cause code is required, who is doing the requiring?  I think the use of external cause codes, which codes are used and when, is up to the facility.  I've heard of facilities that do not want those Y codes used.  Coding guidelines state:  "There is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless a provider is subject to a state-based external cause code reporting mandate or these codes are required by a particular payer, reporting of ICD-10-CM codes in Chapter 20, External Causes of Morbidity, is not required."

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Christine Dundas
Medical Coding Program Coordinator
Miami Dade College
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6.  RE: External cause code required for thrombosis of dialysis graft?????

Posted 8 days ago
Hello Christine & Cristina,
I have been asked to do this by my "supervisor".  I don't know anything more than what I am told (unfortunately).  Also I work for a California institution.  Learning-on-the-fly is what it boils down to.  My goal is always to do the RIGHT think, and I have no guidance with external cause coding...not even from my "supervisor" (who is not an official supervisor).  She has always been mostly involved with ER coding.  I have had to learn everything through my own research & insurance denials.  Honestly, I know NOTHING about OSHPD reporting for California.  Yes, I have read there is no national requirement for external cause code reporting, but my "supervisor" has been adamant that I do.

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Charissa Becker-Martinez, CCS-P
Certified Coder/Abstractor
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