Wiki Impella's

wavesograin

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Have you coded 33999 unlisted procedure for Impella insertion / removals? Medicare has no LCD's and only NCD's in a very broad scope for billing this. They continue to deny for medical necessity, and just wondered if others have encountered this.
 
Yes, we always end up appealing. In the narrative, I add "Impella 2.0, crosswalk to 33975" per the instructions from Abiomed.

We have not had much luck with the removals.

Your mileage may vary.
 
Have you coded 33999 unlisted procedure for Impella insertion / removals? Medicare has no LCD's and only NCD's in a very broad scope for billing this. They continue to deny for medical necessity, and just wondered if others have encountered this.

I havent had any luck with insertions/repositioning/removals. I follow all instructions that I was given from Abiomed, including adding a note on the claim for the type of service, the physician letter and all the inserts they recommend sending. I have found that most Medicare advantage plans are requiring a prior authorization because they view the Impella as experimental still. So, if a prior authorization isnt obtained, we are out of luck.

I havent seen any NCD's for this for Medicare, can someone please include a link to this so that I can review it? I would greatly appreciate it!
 
I appealed one that denied for medical necessity and it came back saying that they determined medical necessity from NCD article 20.9:
http://cms.gov/medicare-coverage-da...CDId=246&ncdver=5&DocID=20.9&bc=gAAAAAgAAAAA&


Which, I am waiting on the provider's office to hear back from Abiomed, because they were specifically told that Impella does not fall under the scope of 20.9, even though that's exactly what CMS said in their reply.
 
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