J1 MAC: Percutaneous Endovascular Cardiac Assist Covered
It isn’t every day a Medicare administrative contractor (MAC) says it will cover a procedure that has neither a specific CPT® code describing it nor any concrete proof that the medical intervention is even useful. On July 16, however, Palmetto GBA did exactly that when it posted a policy update for percutaneous endovascular cardiac assist procedures and devices.
Effective for dates of service on or after Sept. 1, 2011, the jurisdiction 1 Part B MAC will cover the percutaneous insertion of an endovascular cardiac assist device and the device itself.
Coverage will be allowed for (but not exclusively) the following ICD-9-CM codes:
- Cardiogenic shock, reported with 785.51
- Severe decompensated heart failure with threatening multi-organ failure, represented by one of the following:
- 428.21 Acute systolic heart failure
- 428.23 Acute or chronic systolic heart failure
- 428.41 Acute combine systolic and diastolic heart failure
- 428.43 Acute or chronic combined systolic and diastolic heart failure
- 429.4 Functional disturbances following cardiac surgery
- 997.1 Cardiac complications, not elsewhere classified
When submitting a claim to Palmetto for an endovascular cardiac assist procedure, report CPT® 33999 Unlisted procedure, cardiac surgery and enter “Impella” or “Tandem Heart” in item 19 of the CMS-1500 claim form or its electronic equivalent.
Source: Palmetto GBA
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