Extravasation vs. Infiltration, and Vesicant Agents: Understanding the Particulars Involved to Avoid Coding Inaccuracies

It is important for coders and all healthcare professionals to know the difference, and why it matters.

Intravenous therapy (IV) is quite common, administered by healthcare professionals on a very regular basis. As common as it may be, however, it’s linked to an unusually high risk of potential harm to the patient. If a complication occurs, a patient could develop a severe wound, lose function of a limb, or even suffer amputation. Understanding the difference between infiltration and extravasation is essential for healthcare professionals, and just as significant for coders.

What is the difference between infiltration and extravasation?

Whether infiltration or extravasation, both involve an IV solution or medication getting into the tissue surrounding the vein. It is the type of solution or medication that is inadvertently delivered into the surrounding tissue that determines the difference.

Infiltration is the unintentional administration of a non-vesicant medication into surrounding cell tissue. This is a relatively common and generally minor occurrence. Infiltration does not usually cause harm, but the medicine or solution may cause redness, swelling, and discomfort around the site.

Extravasation refers to the unintentional administration of a vesicant medication into the surrounding tissue. These are active chemical substances that can cause blistering, and in extreme cases, necrosis. It is not uncommon for a patient to receive a local injection of a reversal agent if extravasation occurs. If left untreated, the patient may have to have debridement or skin grafting, or he or she could suffer disfigurement, loss of function, and even amputation. 

It is important to note that infiltration and extravasation can exist at the same time. Doctors often use infiltration and extravasation interchangeably. Both are caused when the vein leaks or the IV catheter comes out of the vein; however, extravasation is far more severe. Again, the essential difference between infiltration and extravasation is the type of medicine or fluid that is leaked. Extravasation is much more severe than infiltration due to vesicant agents within an IV solution.

Vesicant Agents

It is important to know if the substance that got into the tissue is a vesicant agent. Vesicants and non-vesicants are the two classes of IV solutions. In both IV solutions and medications, however, vesicant agents are highly reactive chemicals that cause cellular-level changes, resulting in serious or even life-threatening complications.

For coders, when determining if there is a code-able occurrence, the agent that has infiltrated must be taken into account. Further considerations include this question: was it treated, or did it impact the stay?

Coders must identify vesicant agents. Some common examples of vesicant medications and fluids include vancomycin, potassium chloride, calcium gluconate, dopamine, and Dilantin. This type of data may not always be easily accessible. If the coder is in doubt, they must take it one step further – utilize Internet resources, contact a supervisor, or leverage the expertise of a clinical documentation improvement (CDI) colleague. Information can be accessed through the utilization of resources. It is important to leverage all available resources to obtain a true and accurate diagnosis.

Accurate coding and documentation of infiltration and extravasation requires a complete understanding of the difference between the two, and may warrant a more comprehensive examination. For coders, additional efforts may be required to ensure accuracy, in consideration of the many areas that are dependent upon the codes, such as the reputation and quality of the organization, as well as research, and certainly reimbursement.

In keeping up with the expanding complexities of coding and the direct effect codes have on diagnosis assignment, more than ever before, coders must utilize critical thinking skills and all available resources.

Programming Note: Listen to Susan Gatehouse report this story live during Talk Ten Tuesdays today, 10-10:30 a.m. EST.