Coding Tip: PCS Coding for Impella External Heart Assist Device
RHIT, CDIP, CCS, CCS-P
Director of Coding Quality Assurance
AHIMA Approved ICD-10-CM/PCS Trainer
What is the Impella® external heart assist device?
It is a minimally invasive, catheter-based external cardiac assist device. The pump is inserted percutaneously into the left ventricle (through a peripheral artery). The Impella® is inserted to provide hemodynamic support to a patient that has depressed heart function and is often used in patients with cardiogenic shock. The Impella® device pumps blood for the left or right side of the heart into the ascending aorta or pulmonary artery. This is used to rest the patient’s heart during PCI procedures and prevents the heart from being overstressed while the coronary artery blockages are repaired. The device maintains blood flow and blood pressure during the procedure. The device is also used in patients with advanced heart failure and has the ability to improve the quality of life for these patients when there are no other options available for treatment.
Only assistance (5A0) is reported when the Impella® device is removed at the end of the procedure. The insertion is not coded. Per the OCG for ICD-10-PCS FY 2017, the insertion of a device is coded only if the device remains after the procedure is ended. So, if a patient is having PTCA and Impella® is utilized for support and removed at the end of the procedure the insertion is not reported.
If the Impella® device is left in place for a few hours post-surgery/procedure, the insertion of the device (02H) should be coded along with the assistance (5A0). If the device remains after the procedure has ended it should be reported. According to the National Quality Forum (NQF), surgery ends after all the incisions or procedure routes have been closed, all instruments removed, and final surgical counts have been performed and the patient is taken from the operating/procedure room. For example, if a patient is taken from the cardiac catheterization lab after PTCA, and the Impella® device was utilized and still in place, it would be reported as insertion and assistance, even if only for an hour post procedure. If removal is performed, this would also be reported (02P).
Only removal of the device is reported when a patient transfers to a facility with the Impella® device already in place and it is subsequently removed. The transferring facility will report the insertion of the device.
Note: At this time there is no intermittent setting on the Impella® device and this should be reported with the duration value as “continuous”.
So, to sum things up:
- If the Impella® device is used for support during a surgery or a procedure, assistance (5A0) is reported.
- If the Impella® device is removed at the end of the procedure an ICD-10-PCS code for the insertion (02H) of the device is not reported
- If the Impella® device is left in place at the end of the procedure an ICD-10-PCS code for the insertion of the device and assistance is reported.
- If patient presents to your facility with the Impella® device already in place and it is removed, only code the removal (02P) (the transferring facility will code the assistance and insertion)
- All Impella® device assistance is coded as “continuous” at this time.
AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS, First Quarter 2017 Pages: 10-12
AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS, Fourth Quarter 2016 Pages: 137-140
AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS, Third Quarter 2014 Page: 9
AHA Coding Clinic® for ICD-9-CM, Third Quarter 2009 Page: 12
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
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