How to Code Fibrin Sheath Disruption During Dialysis Catheter Procedures 

What Is a Fibrin Sheath and Why Does It Cause Catheter Dysfunction? 

Periodically, patients with dialysis or perma-catheter experience stenosis due to a fibrin sheath, which is a common complication of central venous catheters. A fibrin sheath is a “heterogeneous matrix of cells and debris that form around catheters,” essentially creating an adhesion-like barrier around the catheter. 

This complication can cause stenosis and limit flow through the catheter, often resulting in the need for catheter replacement. 

Clinical Overview: Fibrin Sheath Disruption and Catheter Replacement 

The fibrin sheath must be disrupted or broken up to allow placement of a new catheter and remedy the stenosis and flow limitations caused by the extra lining in the vessel. 

First, the current catheter must be removed. Then, a dilator is placed over a guidewire and the vessel and sheath are balloon dilated from the inside. This re-opens the vessel, allows passage and placement of a new catheter, and restores catheter function. 

Coding Guidance for Disruption of a Fibrin Sheath 

When “disruption of fibrin sheath” is documented, what is the correct coding? 

Thankfully, we have Coding Clinic guidance (3rd Quarter 2018, page 10) for clarification. This Coding Clinic states that disruption of a fibrin sheath should be coded as a dilation of the vessel. 

This code will be reported in addition to the catheter exchange code, if an exchange is also performed during the same encounter. 

Coding Tip: Fibrin Sheath Disruption vs Thrombus Removal 

When documentation states “fibrin sheath disruption,” “balloon disruption,” or “angioplasty of the fibrin sheath”, remember that this procedure is coded as venous angioplasty (dilation of the vessel), not as a thrombus removal or mechanical catheter complication. 

Documentation Elements Needed for Accurate Code Assignment 

To ensure accurate code capture, look for these key documentation elements: 

• Balloon dilation performed within the vein 
• Disruption of fibrin sheath to restore catheter function 
• Catheter exchange occurring in the same session (if applicable) 
• Coding Reminder:
  Code the venous dilation/angioplasty plus the catheter exchange when both procedures are performed. 



Kendra Adams, RHIT 

Senior Consultant, Audit at UASI

With a background in health information technology and ICD-10 coding, Kendra Adams serves as a Senior Consultant in Audit at UASI. She contributes clear, practical coding tips rooted in real-world audit work to help coders improve accuracy, documentation quality, and compliant code assignment. 

Works Cited 

American Hospital Association. (2018). Disruption of fibrin sheath (venous dilation guidance). AHA Coding Clinic for ICD-10-CM/PCS, Third Quarter 2018, p. 10. 

PubMed Central (PMC). (2013). Fibrin sheath angioplasty: A technique to prevent superior vena cava stenosis secondary to dialysis catheters. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC3578630/ 

Renal Fellow Network. (2023). Disrupting catheter-associated fibrin sheath formation. Available at: https://www.renalfellow.org/2023/04/25/disrupting-catheter-associated-fibrin-sheath-formation/