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.
Back in April, the Office of the Inspector General (OIG) published a report detailing its findings from a review of two groups of high-risk diagnosis codes, acute stroke and major depressive disorder. The objective was to determine whether selected diagnosis codes submitted to the Centers for Medicare and Medicaid Services for use in CMS’s risk adjustment program complied with Federal requirements.
There seems to be differences of opinions on the issue of a 40w0day gestation Can you clarify if P08.21 should be assigned for 40w0day infant or if it would not be assigned unless the infant’s gestation age was 40w1day or greater?
Coders may find situations where a patient is documented as meeting SIRS or sepsis criteria, or has some clinical indicators reflective of possible sepsis, but the physician never documents sepsis as a diagnosis. Should the coder always query for sepsis in these instances?
In this example, would it be appropriate to code the complication code T82.03XA, Leakage of heart valve prosthesis, initial encounter as the principal diagnosis over the HFpEF (heart failure exacerbation) code?
We interviewed our most productive coders and reviewers, asking them what steps they take to find a rhythm that works for them. This week, we talked with Kerry Atkins, CDIP, CCS‑P, COC, CPC, CPCO, CPMA, CEMC, COBGC, RMB, Physician Services Consultant at HIA, about the steps she takes to find her routine.
A higher CMI corresponds to increased consumption of resources and increased cost of patient care, resulting in increased reimbursement to the facility from government and private payers, like CMS. We know that documentation directly impacts coding.
With the implementation of ICD-10-PCS more codes were developed in order to accurately report procedures. Spinal fusion coding is still a problematic coding issue and at times, even a coder’s nightmare. Coders often report only the code for the fusion thinking that one code would include all of the other procedures that are performed.
Answer: I would code 0HPT0NZ for removal of tissue expander from right breast, open and change 0HPT0JZ, removal of synthetic substitute from right breast, open, for removal of the acellular dermal matrix to 0HPT0KZ, Removal of nonautologous tissue substitute from right breast, open approach.
There are certain conditions that have instructional notes in the ICD-10-CM tabular/coding conventions that guide the coder in sequencing. This is especially true when the condition has a common manifestation or underlying conditions of a chronic disease. If there is a “code first” note in the tabular, the coder should follow this instruction and sequence the underlying etiology or chronic condition first followed by the manifestation as an additional diagnosis.
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and reviewers and asked them what steps they take to find a rhythm that works for them. This week, we talked with Meghan Schumacher, CPC, CPMA, Provider Coding Consultant at Health Information Associates, Inc., about the steps she takes to find her routine.
Last year, the Office of Inspector General (OIG) performed an investigation that found, “between 2014 and 2016, Medicare Advantage organizations overturned 75% of their preauthorization and payment denials upon appeal,” which is why, at HIA, we always advise our clients to engage in the appeals process.
There may be instances where a coder will suspect the patient has acute kidney injury (AKI), but the physician has failed to document the diagnosis. In another scenario, the physician may have made the diagnosis, but there is a question of clinical validity. In either case, a query would be justified.
Changes to CC/MCC designations included in the proposal could have a potentially dramatic effect on casemix. The presence of a major complication or comorbidity (MCC) or complication or comorbidity (CC) generally is representative of a patient that requires more resources.
How many times have you heard “it only takes one code to get the claim paid”? With the emphasis on the severity of illness and the move toward value-based reimbursement in today’s healthcare climate, it is more important than ever for coders to report all applicable diagnoses. There are three important pieces: what the provider documents, how to the coder interprets that documentation and codes it, and then how it is extrapolated.
The reimbursement landscape is already a complicated one – and the highly-complex claims denials process only adds fuel to the fire. A denied claim is one that has been determined by a payor to be in appropriate. Once a coding specialist amends the errors on a rejected claim, they can resubmit it for consideration. The time-intensive process has a significant impact on the cash flow for any setting in the healthcare environment. They are also very costly to appeal.
When a practitioner documents a diagnosis that does not appear to be supported by the clinical indicators in the health record, a coder has four choices: (1) Code the diagnosis; (2) Ignore the diagnosis; (3) Generate a query to confirm clinical validation of a diagnosis; (4) Follow the facility’s escalation policy for clinical validation.
A California-based healthcare services provider and several of its affiliates have agreed to pay $30 million to resolve allegations they submitted inaccurate information about the health status of beneficiaries enrolled in Medicare Advantage Plans, according to the Department of Justice.
Happy National Volunteer Week! This week we celebrate the impact volunteer work has on building stronger communities. We know that our staff have a positive impact while they’re on the job, and we are proud to share a few ways our #PeopleBehindTheNumbers are taking time to volunteer in their own local communities.
Scrutiny of coding compliance in the growing ambulatory surgical center (ASC) market has increased in recent years from both Medicare and private payers. This will only increase as the Centers for Medicare and Medicaid Services (CMS) moves towards value-based care.
Patients being admitted for acute renal failure due to dehydration have been happening for many, many years now. Typically what happens is a patient gets dehydrated for one reason or another. Once dehydration sets in, it can quickly start to affect many body organs. This can lead to acute renal/kidney failure/injury.
In December 2018, a Pennsylvania for-profit hospital and health system, and its CEO agreed to pay a total of $12.5 million to settle allegations they submitted false claims to Medicare and other federal health care programs for orthopedic surgeries. The settlement resolves allegations that top executives exploited a loophole – AKA modifier 59 – that allowed them to double bill federal healthcare payers for surgeries and ignored coding consultants who advised them that they were improperly billing.
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Zahra Ghahremani, CCS, Coding Specialist at Health Information Associates, about the steps she takes to find her routine.
All queries require at least two elements – clinical indicators and a query question. Coders can also include multiple choice options for response or leave the query open-ended for a free text response. The order in which these elements are listed in a query is open to coder or facility preference.
One area that coders struggle with is when to report a separate condition code when an already assigned combination code includes the condition. For example, if an obstetric patient is admitted and delivers, and the physician documents “obstetric patient delivered with anemia,” should both code O99.02 Anemia complicating childbirth and D64.9, Anemia, unspecified be coded or should only O99.02 be assigned?
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Donna Cowan, RHIT, CCS, Coding Specialist at Health Information Associates, about the steps she takes to find her routine.
The key to choosing reasonable options for a query response is to remember that the query must stand alone. Any clinical indicators supporting the options must be included in the query itself. In this week’s Query Tip, we provide examples of two queries in which the options for response are not reasonable based on clinical indicators used by coder.
Last week, we looked at tidbits for reporting the ICD-10-CM codes for pregnancy/obstetric records. Now we will look at some for the ICD-10-PCS reporting of these records. In reporting the appropriate ICD-10-PCS codes a coder must know what is included in the terminology of products of conception (POC).
Chances are, we all know someone affected by heart disease and stroke, because about 2,300 Americans die of cardiovascular disease each day, an average of 1 death every 38 seconds. But together we can change that.
There was a time when coding delivery records was considered simple. Many times, these types of records were given to the newer coders. However, as coding becomes more complex, this is no longer the case. With the implementation of ICD-10-CM came more codes for very detailed and specific issues that occur during pregnancy, childbirth and the puerperium.