Cardiology Coding Alert

Answer: When the physician removes an existing peripheral ventricular assist device (pVAD) and inserts a new one at the same session, you should report only the insertion code. Choose from these two codes:

Support: CPT® guidelines for ventricular assist devices state, “Replacement of a percutaneous ventricular assist device is reported using implantation codes (i.e., 33990, 33991). Removal (i.e., 33992) is not reported separately.”

 

Both 33990 and 33991 represent pVAD insertion, so the main distinguishing feature is how the physician accesses the heart.

 

Choose 33990 if the pVAD service involves access through an artery only. Documentation typically will show the physician using femoral artery access to introduce the catheter and then maneuvering the catheter up the aorta, across the aortic valve, and then into the left ventricle.

 

Code 33991 is appropriate when the physician inserts catheters into both a vein and artery. A typical service involves the provider inserting catheters into the femoral artery and femoral vein. He advances the venous catheter up to the superior vena cava. He moves the arterial catheter until it’s above the aortic valve. He introduces a transseptal puncture needle through the venous catheter and punctures the septum. This service is fairly rare.

 

Code 33991 represents significantly more work, and Medicare pays roughly $200 more for it, with a national rate of $661.65 for 33991 and $453.87 for 33990.

 

Bonus tips: Vascular surgeons may perform open femoral exposure for the pVAD service and report it separately. For instance, the vascular surgeon may report 34812 (Open femoral artery exposure for delivery of endovascular prosthesis, by groin incision, unilateral). The vascular surgeon also may perform and report blood vessel repair (such as 35226, Repair blood vessel, direct; lower extremity) or graft repair (such as 35286, Repair blood vessel with graft other than vein; lower extremity). Vascular surgeons also often remove the pVAD when it’s removed at a different session than placement, whether the same day or a different day (33992, Removal of percutaneous ventricular assist device at separate and distinct session from insertion). 

 

If the cardiologist removes the pVAD at the same session as placement, for instance if he placed the pVAD for only the length of an electrophysiology procedure, the cardiologist should not report 33992. Report only insertion when the physician inserts and removes the pVAD at the same session.