What is the ICD10 code for removal of a Central Venous Catheter (CVC) in a patient undergoing renal recovery?

ICD-10 Coding for CVC Removal in Renal Recovery Patients

The appropriate ICD-10 procedure code for removal of a central venous catheter is 05HP33Z (Removal of Infusion Device from Right Subclavian Vein, Percutaneous Approach) or the corresponding code for the specific vein accessed, with the diagnosis code Z49.31 (Encounter for adequacy testing for hemodialysis) or Z99.2 (Dependence on renal dialysis) transitioning to N18.9 (Chronic kidney disease, unspecified) as the patient recovers renal function.

Clinical Context for CVC Removal in Renal Recovery

Indications for Catheter Removal

Promptly remove any intravascular catheter that is no longer essential 1. In patients experiencing renal recovery, the CVC should be removed as soon as alternative vascular access (such as a fistula or graft) becomes functional or when dialysis is no longer required 1.

• Use a fistula or graft in patients with chronic renal failure instead of a CVC for permanent access for dialysis 1
• CVCs should not be routinely replaced to prevent infection; removal is indicated when the catheter is no longer clinically necessary 1

Timing Considerations

The decision to remove a dialysis catheter in a recovering patient should account for:

• Confirmation of sustained renal recovery with adequate native kidney function to eliminate dialysis dependence
• Absence of active infection at the catheter site or bloodstream 1, 2
• Hemodynamic stability of the patient 1, 2

ICD-10 Coding Structure

Procedure Codes (ICD-10-PCS)

The specific code depends on the anatomical location:

• 05HP33Z: Removal of Infusion Device from Right Subclavian Vein, Percutaneous Approach
• 05HN33Z: Removal of Infusion Device from Left Subclavian Vein, Percutaneous Approach
• 05HM33Z: Removal of Infusion Device from Right Internal Jugular Vein, Percutaneous Approach
• 05HL33Z: Removal of Infusion Device from Left Internal Jugular Vein, Percutaneous Approach
• 05HV33Z: Removal of Infusion Device from Right Femoral Vein, Percutaneous Approach (though femoral access should be avoided in dialysis patients) 1

Diagnosis Codes (ICD-10-CM)

Primary diagnosis codes for renal recovery context:

• N18.9: Chronic kidney disease, unspecified (for patients with improving but not fully recovered renal function)
• Z49.31: Encounter for adequacy testing for hemodialysis (if assessing whether dialysis can be discontinued)
• Z99.2: Dependence on renal dialysis (transitioning status)
• Z45.2: Encounter for adjustment and management of vascular access device (for the catheter removal encounter itself)

Common Pitfalls in Coding

Avoid Premature Removal

Do not remove CVCs on the basis of fever alone 1. Use clinical judgment regarding the appropriateness of removing the catheter if infection is evidenced elsewhere or if a noninfectious cause of fever is suspected 1.

• In patients with suspected catheter-related infection, more than 70% of catheters yield negative cultures, meaning unnecessary removal occurs frequently 1, 3

Document Catheter Characteristics

For accurate coding, documentation should specify:

• Catheter type: tunneled versus non-tunneled 1
• Insertion site: subclavian, jugular, or femoral 1
• Reason for removal: renal recovery, infection, malfunction, or elective 1

Special Considerations for Infected Catheters

If the catheter is being removed due to infection rather than renal recovery alone:

• Add appropriate infection codes such as T80.211A (Bloodstream infection due to central venous catheter, initial encounter) 2, 4
• Document the specific organism if cultures are positive (e.g., B95.61 for MRSA, B96.20 for unspecified E. coli) 2, 4
• For S. aureus, Pseudomonas, or Candida infections, always remove the catheter 1, 2

Documentation Requirements

Ensure the medical record includes:

• Clear indication that renal function has recovered sufficiently to discontinue dialysis
• Catheter location and type (e.g., "right internal jugular tunneled hemodialysis catheter")
• Absence of complications such as infection, thrombosis, or mechanical dysfunction at time of removal 1
• Plan for future vascular access if dialysis may be needed again