Central venous catheters are used in hospital to give medications, fluids, nutrients or blood products over a long period of time, or to monitor central venous pressure during or following surgery. The code for the insertion of a central venous catheter (1.IS.53.^^) is mandatory for both inpatient and ambulatory care coding.
However, the insertion of a central venous catheter is also a required and inherent part of certain interventions (such as open heart surgery). The Canadian Coding Standards stipulate that interventions that are an inherent part of an overall intervention are not coded separately.
1.IS.53.^^ currently qualifies as a flagged intervention in CIHI’s Case Mix Group+ (CMG+) methodology. The intent of the flagged intervention adjustment is to identify specific cases within a CMG where the patient might be expected to consume more resources than other patients in the same cell. Flagged interventions may, and do, occur in any CMG within the case mix methodology. Assigning codes for flagged interventions is currently mandatory. The insertion of a central venous catheter is also an ambulatory intervention and groups in the Comprehensive Ambulatory Classification System (CACS) methodology.
A review of CIHI data has shown that some institutions are coding the insertion of central lines in all cases (such as with open heart surgery) and other institutions are not.
V2015 of ICD-10-CA and CCI and the Canadian Coding Standards for Version 2015 of ICD-10-CA and CCI will be updated to clarify the correct coding of central venous catheters. A review of the CMG+ grouping methodology for v2015 is under way.
In the interim, continue to code the insertion of central venous catheters when performed alone. Their insertion should not be coded when done with another intervention. CIHI will monitor this through open-year data mining and will follow up with hospitals that consistently show coding of central venous catheters with another intervention in the same intervention episode.