Intraosseous Administration

This month’s “In the kNOW” will discuss intraosseous (IO) administration coding in ICD-10-PCS.  This procedure can be considered an intraosseous blood transfusion meaning blood products are administered through veins inside a bone. 

Typically, coding professionals will see these types of transfusions performed in emergency situations when other methods of venous access are not available. Collapse or constriction of veins during cases of cardiopulmonary arrest or systemic shock make this a particularly useful method to achieve venous access.  IO access can be used to administer blood, medications, or fluids, or for blood draws.  It is important to note that this procedure is not a bone marrow transplant.

Adult access is generally in the proximal humerus or proximal tibia and achieved with a power drill.

Source: https://psnet.ahrq.gov/web-mm/benefits-vs-risks-intraosseous-vascular-access

IO access in children is generally in the proximal or distal tibia and performed with a punch technique.  

Source: https://www.youtube.com/watch?v=JpnCG5OZm_E

For both adults and children, the bone marrow transfusion approach is percutaneous with the Qualifier either autologous or non-autologous. 

To correctly code for the IO access, you cannot use the ICD-10-PCS tables for upper and lower bones.  Instead, you have to go to the Anatomic Regions, lower or upper extremities tables (0YH-lower) (0XH-upper) for the insertion of an infusion device.  Check with your organization to see if there are any facility specific guidelines that determine if you should assign codes for both the access and the transfusion. 

Now you are In the kNOW!!

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About the Author 

Dianna Foley, RHIA, CCS, CHPS, CDIP is OHIMA's Education Coordinator. Dianna has been an HIM professional for over 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She previously served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati and holds RHIA, CHPS, CDIP and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and is a presenter on coding topics at the national, state, and regional levels. Dianna mentors new AHIMA members and also provides monthly educational lectures to coders and clinical documentation specialists.