Does anyone have any guidance on coding two Impellas inserted on the same day. Impella CP (left) is coded with CPT 33990 with a MUE of 1. Can I code the second visit to the OR (Facility coding) with a modifier. Patient has commercial insurance.
Encounter One:
Patient presented with anterior wall STEMI. Export catheter was inserted over the .014 guidewire for thrombus aspiration. Patient required Impella CP device for hemodynamic support. Given cardiogenic shock, Impella CP was placed through right common femoral artery access site. Patient was admitted to CVICU.
Encounter Two – return to OR
Five hours later CVICU noted that the Impella CP had migrated into the ascending aorta/arch. He has significant lactic acidosis, is in pulmonary edema, intubated and is on 2 pressor (Epi and Levo) He also has absent pulses by doppler in both distal LE with plan for evaluation by vascular per CT Surgery. We have been requested by primary cardiologist to remove the old Impella and re-insert a new one.
Using pigtail, we crossed into the LV from the radial access site and used it as guide to push the Impella across. Despite multiple attempts, we were not able to prolapse the Impella CP across the patient's aortic valve. Our next plan was to use a snare through JR4 guide and use it to snare the tip of the Impella pigtail and push it across the aortic valve. However, we noted that there is spasm in the radial artery and did not resolve with nitroglycerin. Hence, we decided to proceed with Impella removal and insertion of new device.
Encounter One:
Patient presented with anterior wall STEMI. Export catheter was inserted over the .014 guidewire for thrombus aspiration. Patient required Impella CP device for hemodynamic support. Given cardiogenic shock, Impella CP was placed through right common femoral artery access site. Patient was admitted to CVICU.
Encounter Two – return to OR
Five hours later CVICU noted that the Impella CP had migrated into the ascending aorta/arch. He has significant lactic acidosis, is in pulmonary edema, intubated and is on 2 pressor (Epi and Levo) He also has absent pulses by doppler in both distal LE with plan for evaluation by vascular per CT Surgery. We have been requested by primary cardiologist to remove the old Impella and re-insert a new one.
Using pigtail, we crossed into the LV from the radial access site and used it as guide to push the Impella across. Despite multiple attempts, we were not able to prolapse the Impella CP across the patient's aortic valve. Our next plan was to use a snare through JR4 guide and use it to snare the tip of the Impella pigtail and push it across the aortic valve. However, we noted that there is spasm in the radial artery and did not resolve with nitroglycerin. Hence, we decided to proceed with Impella removal and insertion of new device.