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.
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.
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.
Intraoperative Use:
Post-Operative Use:
Device Removal:
Monitoring and Assistance:
By understanding these nuances, coders can accurately report the use of the Impella® External Heart Assist Device.
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.
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