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What is the Impella® External Heart Assist Device?
The Impella® is a minimally invasive, catheter-based cardiac assist device. It is primarily inserted percutaneously into the left ventricle via a peripheral artery, though it can also be inserted through open or percutaneous endoscopic approaches. In this discussion, we focus on the percutaneous approach.
Clinical Use
The Impella® device is designed to provide hemodynamic support to patients with depressed heart function, commonly used in cases of cardiogenic shock. It assists by pumping blood from the left or right side of the heart into the ascending aorta or pulmonary artery. This support allows the heart to rest during procedures like percutaneous transluminal coronary angioplasty (PTCA), preventing overstress while coronary artery blockages are addressed. Additionally, the Impella® is used in patients with advanced heart failure, offering improved quality of life when other treatment options are not feasible.
ICD-10-PCS Coding for Impella®
In October 2017, a significant update was made to ICD-10-PCS coding for the Impella® device. The qualifier “intraoperative” was added to code table 02H Insertion into Heart and Great Vessels to report the insertion of short-term external heart assist systems. Previously, only an Assistance procedure from table 5A0 was coded when the Impella® was inserted and removed during surgery. With the new qualifier, both insertion of the device, 02HA3RJ (Insertion of short-term external heart assist system into heart, intraoperative, percutaneous approach) and assistance, 5A0221D (Assistance with cardiac output using impeller pump, continuous) can be reported for devices inserted and removed during surgery.
Key Coding Scenarios
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Intraoperative Use:
- If the Impella® device is inserted and removed during the same operative episode, report:
- 02HA3RJ: Insertion of short-term external heart assist system into heart, intraoperative, percutaneous approach.
- 5A0221D: Assistance with cardiac output using impeller pump, continuous
- If the Impella® device is inserted and removed during the same operative episode, report:
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Post-Operative Use:
- If the Impella® device remains in place post-procedure, the intraoperative qualifier does not apply. For example, if a patient leaves the cardiac catheterization lab with the device still in place, report:
- 02HA3RZ: Insertion of short-term external heart assist system into heart, percutaneous approach.
- 5A0221D: Assistance with cardiac output using impeller pump, continuous.
- If the Impella® device remains in place post-procedure, the intraoperative qualifier does not apply. For example, if a patient leaves the cardiac catheterization lab with the device still in place, report:
-
Device Removal:
- When a patient leaves the operating suite with the device in place, removal of the device at a later time is reported separately with a code from table 02P Removal from Heart and Great Vessels. The body part, approach and qualifier characters will vary depending on the documentation.
- If the patient is transferred to another facility, the transferring facility codes the insertion and assistance, while the receiving facility codes assistance and removal.
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Monitoring and Assistance:
- Monitoring of the Impella® device outside of the operating room is coded as 5A0221D for Assistance. Coders should determine if the assistance was intermittent or continuous, as this affects coding.
Summary for Coders
- Insertion for use During Surgery Only:
- Intraoperative insertion and removal: 02HA3RJ and 5A0221D.
- Insertion for use Intra and Post-Operatively:
- Device left in place post-procedure: 02HA3RZ and 5A0221D.
- Post-Procedure:
- Device removal only: Code the removal procedure (02P).
- Continuous or intermittent assistance: Review documentation to ensure accurate coding of duration.
By understanding these nuances, coders can accurately report the use of the Impella® External Heart Assist Device.
About our Impella® Device Coding in ICD-10-PCS Course
In this course, coders will gain comprehensive knowledge of the Impella device, a percutaneously inserted ventricular assist device (VAD) used in critical cardiac situations. Participants will learn about the Impella device's purpose, functionality, and master the intricacies of coding its insertion, removal, and revision in the ICD-10-PCS coding system. Detailed lessons will explore various scenarios, including the use of the Impella 5.5 with SmartAssist system in the ascending aorta. The course also addresses relevant coding clinic guidelines, considerations for different approaches, and provides practical coding examples to ensure accurate coding practices for external heart assist devices.
HIAlearn, powered by Health Information Associates (HIA)—a leader in medical coding and auditing for over 30 years—offers a comprehensive online education platform for medical coders. With a catalog of over 200 medical coding courses accepted by the American Health Information Management Association (AHIMA) for Continuing Education Units (CEUs) and a selection accredited by the American Academy of Professional Coders (AAPC), HIAlearn caters to both beginners and experienced medical coders seeking to enhance their skills. The platform provides an array of training plans tailored to meet individual learning needs, from mastering challenging coding procedures to understanding broad conceptual frameworks within the coding world. Courses are available across various coding types including CPT, E/M, ICD-10-CM, ICD-10-PCS, and are designed to cater to different coder levels and coding specialties such as inpatient, outpatient, profee, and CDI. Additionally, HIAlearn offers a Coding Updates bundle to ensure coders are up-to-date with the annual changes in ICD-10-CM, ICD-10-PCS, CPT, and IPPS. Beyond individual learning, HIAlearn supports organizations with group discounts, promoting enhanced coding accuracy, efficiency, and compliance across teams. With over 1,600 users already part of the HIAlearn community, the platform stands as a testament to its commitment to providing quality education and support for medical coders nationwide.
The information contained in this blog post 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.
