ICD-10-PCS Coding for Impella External Heart Assist Device

What is the Impella® external heart assist device?

It is a minimally invasive, catheter-based external cardiac assist device. The pump is most often inserted percutaneously into the left ventricle (through a peripheral artery). However, the device may be inserted open or percutaneous endoscopic as well. For this coding tidbit, we are using percutaneous approach. 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 percutaneous coronary intervention (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 can improve the quality of life for these patients when there are no other options available for treatment.

ICD-10-PCS Reporting:

In October 2017, the qualifier “intraoperative” was added to 02H for insertion of short term external heart assist system. Previously, guidance was to only code the assistance procedure (5A0) when the Impella® was inserted during surgery only and removed. However, with the addition of this qualifier, coders are now to report both 02HA3RJ  Insertion of short-term external heart assist system into heart, intraoperative, percutaneous approach  and 5A0221D  Assistance with cardiac output using impeller pump, continuous for this heart assist device used for surgery only.

If the Impella® device is left in place for a few hours post-surgery/procedure, the intraoperative qualifier would no longer apply since the device was still utilized after the patient left the operating 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, with continuous monitoring, it would be reported as 02HA3RZ Insertion of short-term external heart assist system into heart, percutaneous approach and 5A0221D Assistance with cardiac output using Impeller pump, continuous. This is because there is not a qualifier for “temporary” for 02H and this is no longer just an “intraoperative” use of the device.

The removal of the device is reported when a patient leaves the operative suite with the Impella® device already in place and it is subsequently removed.

If the patient is transferred to another facility, the transferring facility will report the insertion of the device. If there is any monitoring during the time the patient is at the second hospital, the code 5A0221D would be reported as well. When the device is removed, the facility will also code the removal of the device.

Note: A “Duration” of intermittent setting on the Impella® device has been added along with “continuous” so coders must look at the medical record to ascertain if the duration was intermittent or continuous.

So, to sum things up:

• If the Impella® device is used for support during a surgery or a procedure, and removed at the end of the procedure, insertion with intraoperative qualifier (02HA3RJ) AND assistance (5A0) are 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 WITHOUT intraoperative qualifier, 02HA3RZ and assistance (5A0) are 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)
• 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) If there is any monitoring during the time the patient is at the second hospital, the 5A0221D would be reported as well.
• Impella® device assistance is coded as “intermittent” or “continuous” at this time.

Authored by Kim Boy, RHIT, CDIP, CCS, CCS-P

References:
AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS, Fourth Quarter 2017: Page 42, 71
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
wikipedia.org/wiki/Impella

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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.