The Impella® External Heart Assist Device: Essential Insights for Medical Coders

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

1. 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

2. 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.

3. 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.

4. 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.

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.