J1-MAC Updates Percutaneous Endovascular Cardiac Assist Coverage
Effective for dates of service on or after Sept. 1, 2011 Palmetto GBA will cover the percutaneous insertion of an endovascular cardiac assist device and the device itself.
“The impella has the capacity of being inserted into the heart from a peripheral location (femoral/axillary/iliac artery). The location of insertion is dictated by the patient anatomy. While femoral artery insertion is the most common, the axillary, iliac or subclavian arteries may provide more appropriate access when peripheral vascular disease or small femoral vessels are present,” Palmetto GBA says in an article (updated Oct. 5) posted on its website.
According to Palmetto GBA, “The literature does not clearly demonstrate when this approach is most useful,” but the jurisdiction 1 Medicare Administrative contractor (J1-MAC) will allow coverage for (but not exclusively) the following ICD-9-CM codes:
- 785.51 Cardiogenic shock
- Severe decompensated heart failure with threatening multi-organ failure, represented by one of the following ICD-9-CM codes:
- 428.21 Acute systolic heart failure
- 428.23 Systolic heart failure, acute on chronic
- 428.41 Acute combined systolic and diastolic heart failure
- 428.43 Acute on chronic combined systolic and diastolic heart failure
- 429.4 Functional disturbances following cardiac surgery
- 997.1 Cardiac complications not elsewhere classified
There aren’t any CPT® codes that accurately describe endovascular cardiac assist procedures. To report an endovascular cardiac assist procedure, Palmetto GBA requests providers to:
- Submit CPT® code 33999 Unlisted procedure, cardiac surgery.
- Enter the word ‘Impella’ in item 19 of the CMS-1500 claim form or its electronic equivalent.
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