PCS Coding for Impella Device

jlprinz@att.net

Good Afternoon -

       I am reaching out to gain some clarity on correct capture of PCS coding of the Impella Device. The new coding
clinic Fourth Quarter ICD-10 2017 - leads coding to capture all Impella usage to go to Drg 215.  You capture a code
for insertion and a code for  assist. Is this the same interpretation those facilities using this device have ??

Thank you!!

featherz

 Have only seen one impella, but that's how it was coded - two codes, one for the insertion, one for the assist. 

smidgen21

The device rep shared this with our facility.  It was helpful to our team.  

julisa.alanis@christushealth.org

Question:  If a patient comes in with Sepsis and CHF, has Impella inserted, can CHF be PDX? We have 2 different opinions. Thanks

evanspx@sutterhealth.org

Very complex situation, and would need much more information.   Fundamentally, there is a rule that may permit a choice, and you would need to carefully review the record to ensure either as PDX is supported and compliant.  Was the sepsis causing acute organ failures, such as shock, encephalopathy?  Was the CHF causing cardiogenic shock?  What is the chief reason for admission as based on documentation and what was the thrust of care?

Two or more diagnoses that equally meet the definition for principal diagnosis “In the unusual instance when two or more diagnoses equally meet the criteria for principal diagnosis as determined by the circumstances of admission, diagnostic workup and/or therapy

provided, and the Alphabetic Index, Tabular List, or another coding guidelines does not provide

sequencing direction, any one of the diagnoses may be sequenced first.”

This means if a patient presents with multiple conditions that meet the UDHHS definition for principal diagnosis, any one of the conditions could be sequenced as the principal diagnosis, as determined by the circumstances of the admission, diagnostic workup and therapy provided. However,  the fact that two or more conditions are listed as the reasons for admission does not mean a sequencing choice is always an option. When the thrust of treatment is directed primarily towards one condition, it must be used as the principal diagnosis.
Paul Evans
CCDS