Wiki Impella 2.5 Circulatory Support System - Any experience with this?

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DWILHELM

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One of my cardiologists has used the assist device, Impella 2.5, with a couple of his high risk cath procedures and I have had a time getting this covered. For one, it does not have an assigned code (and 92970 is not appropriate as it does not reflect the more complicated level of work performed when utilizing an Impella device) - I feel I may be getting closer, but in the even I get another denial, I thought I would see if someone else out there has had to deal with this Impella issue. I have billed using the unlisted procedure code 33999 with appropriate documentation to support it. I actually billed it twice, one for the insertion and one for the removal (with a 59 on the one for the removal). Any input would be appreciated as I value any and all knowledge from others.

Thanks
 
Hello,

You are on the right track with billing the Impella device. Use 92970 for implant but you cannot bill for the removal as a code has not been assigned for it. Your doctor should have been provided material on billing this device. I spoke with a rep from ABIOMED and was given the material. Dx billed is 428.0-428.9

Dolores, CCC-CPC
 
I wanted to comment by saying we did receive material from Abiomed and it states to use 33975 and 33977 for insert and removal, not 92970. I have now learned that we cannot bill both same day per Medicare edits. I am confused as to what to code because I am not sure if Abiomed is telling us to use these codes, why would we then use 92970 which is minimal work compared to these codes? Any help is appreciated! Thanks, Gail Davis, CPC.
 
We've been successfully billing 33975-52 for an insertion. However, we can not get the removal (33977-52) paid by any carrier. The codes were provided to our clinic by Abiomed, and they recommended using the -52 modifier.

Thanks!
Leah, CPC-A
 
33975 and 33977 were provided by a rep also to our physician.
But what we realized is that these codes describe a "transthoracic approach"

33999- impella 2.5 percutaneous approach without doing a transseptal access
33975- a transthoracic approach
0048T a percutaneous approach with a transseptal access
 
The information I received from Abiomed said to use CPT 92970. The FDA approved this device for "partial circulatory support up to 6 hours of use" and that is why 92970 makes sense to me, because it is temporary assistance during a heart catheterization. The other codes I see here, the 33975 and 33977 could be correct if the the 'assist device' was going to leave the OR room with the patient, since these require cardiopulmonary bypass and the inplanted pump is placed inside a pocket in the abdominal wall. 33975 and 33977 are used more for patients whose left ventricle has failed and it needs support until a ventricle replacement surgery or complete heart transplantation can be performed.

This is, however, only my opinion based on personal research on this subject.
 
Per our Medicare carrier (Noridian):
Medicare B News Issue 263 July 21 2010
Heading: Coverage
Title: Percutaneous Endovascular Cardiac Assist Procedures and Devices

NAS will cover the percutaneous insertion of an endovascular cardiac assist device and the device itself under limited conditions. Until the literature clearly demonstrates the efficacy of the treatment approach, coverage may be made in the following two life-threatening situations and only when external counterpulsation (intraaortic balloon pump, IABP) is not expected to be sufficient:

Cardiogenic shock ICD-9-CM code 785.51, or
Severe decompensated heart failure with threatening multi-organ failure, represented by one of the following ICD-9-CM codes: 428.21, 428.23, 428.41, 428.43, 429.4, or 997.1

Billing Instruction:
Part A Providers - Use ICD-9-CM code 37.68
Part B Providers - Use CPT 33999 with "Impella" entered in Item 19 of the CMS-1500 Claim Form or its electronic equivalent

Effective for dates of service on and after June 14, 2010

We have not been billing for the removal, since an unlisted code shouldn't be used twice, but priced to incorporate the entire procedure (insertion and removal).
 
Impella 2.5

I see that the conversation is older but I am researching this now and don't feel that the 33990 given by the Abiomed is correct. If anyone in this thread or on forum has any other information it would be appreciated. I am actually thinking of charging a 92970 or 33999
 
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