Procedure coding for ECMO and Impella
Does the recent coding clinic advice (Fourth Quarter, 2017 page 137) regarding heart assist device (IMPELLA) also apply to extracorporeal membrane oxygenation (ECMO) in adults?
We recently had a patient transferred from OSH with ECMO, the OSH was unable to wean the ECMO. During the stay the ECMO was managed and setting adjusted. The patient expired but ECMO not removed prior to death.
Would it be appropriate to use procedure code of continuous ECMO 5A15233?
Comments
I have searched extensively and I haven't found a definite answer.
Any further input is appreciated.
From reading medical literature, Impella heart pump device is used for short term assist in cardiac procedures such as PCI to keep the patient alive
In ECMO it is used to keep the patient alive with profound heart failure so it is long term.
I would make sense to use the new IMPELLA CODES ACCORDING TO CODING CLINIC and not the ECMO code
Question:
A patient underwent a percutaneous transluminal angioplasty (PTCA). An Impella® external heart assist device was utilized for intraoperative support, and was removed at the end of the PTCA procedure. Would both the assistance and insertion of external heart assist system codes be reported? Would a removal of external heart assist system code be assigned as well?
Answer:
Effective October 1, 2017, a new qualifier for the intraoperative use of external heart assist systems is available, and a corresponding guideline change has been made. Guideline B6.1a states, "In limited root operations, the classification provides the qualifier values Temporary and Intraoperative, for specific procedures involving clinically significant devices, where the purpose of the device is to be utilized for a brief duration during the procedure or current inpatient stay."
In addition to the code for the PTCA, assign the following ICD-10-PCS codes:
Do not assign a separate code for the removal of the external heart assist system. The insertion code identifies the device as being intraoperative, so a separate code for removal should not be assigned when device is removed during the same intraoperative session.
Question:
Does the fact that an Impella® external heart assist device left in for a few hours postoperatively have any bearing on code assignment? Does the revision of Guideline B6.1.a affect the answer previously published in Coding Clinic,First Quarter 2017, page 11? For example, if a percutaneously inserted device is left in the patient at the completion of the procedure, but is removed within a few hours; how should this be coded?
Answer:
Guideline B6.1a states, "In limited root operations, the classification provides the qualifier values Temporary and Intraoperative, for specific procedures involving clinically significant devices, where the purpose of the device is to be utilized for a brief duration during the procedure or current inpatient stay." However, this guideline does not apply in this case, as the qualifier value Temporary is not available for external heart assist devices. The qualifier value Intraoperative does not apply because the external heart assist system was inserted during the operative procedure and remained after the procedure was completed.
Assign the following codes for this procedure: