AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2016 Quarter 4
Heart Assist Device Systems
An Impella CP left ventricular assist device was introduced via the femoral artery. Left ventricular assist device support was undertaken. The patient’s hemodynamics improved, however, due to changes in left ventricular geometry and increased venous return to the right side, despite inotropic support, there was evidence of significant right ventricular dysfunction in association with low cardiac index. As such, the decision was made to place the Impella RP right ventricular assist device. The right common femoral vein was accessed, and then using a combination of fluoroscopic and transesophageal echo guidance, the Impella RP device was introduced into the left common pulmonary artery. Right ventricular assist device support was undertaken. The patient’s hemodynamics were stabilized and pressure requirements reduced. How are both ventricular assist devices reported in ICD-10-PCS? ...
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Article Overview
This article explains coding considerations for temporary heart assist device systems and related ICD-10-PCS reporting. It focuses on common documentation scenarios involving device insertion, transfer between facilities, removal, and how to interpret access versus procedure approach when a surgical cut-down is documented. The guidance is aimed at coders, CDI professionals, and other revenue cycle staff working with circulatory support procedures and ICD-10-PCS documentation.
Why This Topic Matters
Temporary heart assist devices are increasingly encountered in acute care settings, and documentation can be complex when access site, procedure site, and device support functions differ. Accurate understanding of the article helps readers identify when ICD-10-PCS body part and approach concepts are being discussed so they can review the premium guidance for proper reporting.
Article Sections
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Overview of temporary heart assist devices
Introduces temporary circulatory support devices and the general clinical settings in which they are used. It also frames the documentation and coding questions that arise in hospital care.
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Impella-related coding clarification
Discusses a commonly referenced temporary heart assist device and the general reporting scenarios that prompted clarification. The section centers on insertion, transfer, and removal situations.
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Approach selection and surgical cut-down documentation
Explains how to think about access site versus procedure site when assigning an ICD-10-PCS approach value. It also addresses the relationship between open approach concepts and vascular access documentation.
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Body part and site of procedure considerations
Describes how ICD-10-PCS reflects the definitive procedure site rather than the access site. The section reinforces that device procedures may involve different anatomic targets depending on the case.
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Questions and answers
Presents a worked scenario involving ventricular assist device support and reporting questions. This portion is intended to clarify how the article’s guidance applies in a specific documentation example.
What You Will Learn
- How temporary circulatory support heart assist devices are discussed in ICD-10-PCS coding guidance
- What documentation issues commonly arise with device insertion, transfer, and removal
- How access site and procedure site concepts affect approach selection
- How body part and approach concepts are distinguished in ICD-10-PCS
- How the article frames a ventricular assist device example for further clarification
Who Should Read This
- Hospital coders
- Inpatient coding specialists
- CDI professionals
- Revenue cycle staff
- Health information management professionals
Codes Discussed
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