Current treatment for traumatic arterial injury of the extremities consists primarily of replacement with autologous venous or synthetic graft. However, the need for emergent repair or the unsuitability of a patient’s veins makes harvesting an autologous graft less than ideal and synthetic grafts have a higher instance of infection. Bioengineered human acellular vessels™ or HAVs™ are an infection resistant, universally implantable conduit designed for replacement or repair of arteries damaged by traumatic injury. An advantage of HAVs™ is that they are ready off the shelf, eliminating the need for obtaining a graft from the patient. This saves critical time in revascularizing the patient’s extremities and eliminates the chance of a patient developing infection in a secondary wound.
The wall of a HAV™ is composed of human extracellular matrix (ECM) proteins (collagen types I, III and VI, fibronectin, and other matrix proteins). The HAV™ is manufactured using a proprietary process beginning with human vascular cells that are seeded onto a tubular biodegradable scaffold and cultivated in a sterile bioreactor bag that simulates the pulsatile flow of blood in human arteries. This process creates fully formed, and functional bioengineered human blood vessels. A final decellularization process thoroughly removes cellular and genetic material that could be responsible for immune rejection, while retaining an intact ECM structure and key ECM proteins found in native vessels. The conduit eventually populates with the patient’s own cells and becomes a living tissue.
Beginning October 1, 2024, ICD-10-PCS introduces a device value “Bioengineered Human Acellular Vessel” in the Cardiovascular body system of the New Technology section for New Technology Group 10. The objective of this device is putting in material that physically takes the place of the damaged arteries, which meets the definition of the root operation Replacement. For the body part there are not specific values for specific arteries. The body part value is selected depending only on whether it is an upper or lower extremity artery that is being replaced and the side of the body, right or left. The only approach value available for this procedure is Open.
Coding accuracy after October 1 means that arterial trauma treated with placement of HAV™ requires assignment of a code(s) from the New Technology section with device value W Bioengineered Human Acellular Vessel. Coders should take care not to assign a code(s) from the Upper or Lower Arteries code tables with the root operation Replacement from the Medical and Surgical section of ICD-10-PCS. Knowing what device is being used to accomplish the procedure and being aware that there is a New Technology code specific to HAV™ placement is key to reporting these procedures correctly.
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