SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Percutaneous Ventricular Assist Device

A53986

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
Superseded
To see the currently-in-effect version of this document, go to the section.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A53986
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Percutaneous Ventricular Assist Device
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
01/01/2023
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act (SSA) §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim

Article Guidance

Article Text

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

  • Cardiogenic shock ICD-10-CM code R57.0; or
  • Severe decompensated heart failure with threatening multi-organ failure, represented by one of the following ICD-10 codes: I50.21, I50.23, I50.41, I50.43, I97.110, I97.111, I97.130, I97.131; or
  • Complications/disturbances of the circulatory system intra-operatively or postoperatively: I97.790, I97.791, I97.88 and I97.89.

This service will only be covered when the FDA approval guidelines are strictly adhered to.

Response To Comments

Number Comment Response
1
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Coding Information

Bill Type Codes

Code Description
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Revenue Codes

Code Description
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CPT/HCPCS Codes

Group 1

(8 Codes)
Group 1 Paragraph

The CPT/HCPCS code(s) may be subject to Correct Coding Initiative (CCI) edits. This advice in this article does not take precedence over CCI edits. Please refer to the CCI for correct coding guidelines and specific applicable code combinations prior to billing the A/B MAC.

Group 1 Codes
Code Description
33990 INSERTION OF VENTRICULAR ASSIST DEVICE, PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; LEFT HEART, ARTERIAL ACCESS ONLY
33991 INSERTION OF VENTRICULAR ASSIST DEVICE, PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; LEFT HEART, BOTH ARTERIAL AND VENOUS ACCESS, WITH TRANSSEPTAL PUNCTURE
33992 REMOVAL OF PERCUTANEOUS LEFT HEART VENTRICULAR ASSIST DEVICE, ARTERIAL OR ARTERIAL AND VENOUS CANNULA(S), AT SEPARATE AND DISTINCT SESSION FROM INSERTION
33993 REPOSITIONING OF PERCUTANEOUS RIGHT OR LEFT HEART VENTRICULAR ASSIST DEVICE WITH IMAGING GUIDANCE AT SEPARATE AND DISTINCT SESSION FROM INSERTION
33995 INSERTION OF VENTRICULAR ASSIST DEVICE, PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; RIGHT HEART, VENOUS ACCESS ONLY
33997 REMOVAL OF PERCUTANEOUS RIGHT HEART VENTRICULAR ASSIST DEVICE, VENOUS CANNULA, AT SEPARATE AND DISTINCT SESSION FROM INSERTION
M1151 PATIENTS WITH A HISTORY OF HEART TRANSPLANT OR WITH A LEFT VENTRICULAR ASSIST DEVICE (LVAD)
M1152 PATIENTS WITH A HISTORY OF HEART TRANSPLANT OR WITH A LEFT VENTRICULAR ASSIST DEVICE (LVAD)
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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(13 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
I50.21 Acute systolic (congestive) heart failure
I50.23 Acute on chronic systolic (congestive) heart failure
I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I97.110 Postprocedural cardiac insufficiency following cardiac surgery
I97.111 Postprocedural cardiac insufficiency following other surgery
I97.130 Postprocedural heart failure following cardiac surgery
I97.131 Postprocedural heart failure following other surgery
I97.790 Other intraoperative cardiac functional disturbances during cardiac surgery
I97.791 Other intraoperative cardiac functional disturbances during other surgery
I97.88 Other intraoperative complications of the circulatory system, not elsewhere classified
I97.89 Other postprocedural complications and disorders of the circulatory system, not elsewhere classified
R57.0 Cardiogenic shock
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/01/2023 R8

Under CPT/HCPCS Codes Group 1: Codes added M1151 and M1152. This revision is due to the 2023 Annual/Q1 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/23.

Under CMS National Coverage Policy added the regulation “Title XVIII of the Social Security Act (SSA) §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.” This revision is retroactive effective for dates of service on or after 1/1/23.

01/01/2021 R7

Under CPT/HCPCS Codes Group 1: Codes added codes 33995 and 33997. The description was revised for codes 33990, 33991, 33992, and 33993. This revision is due to the Q1 2021 CPT/HCPCS code update and has a retroactive effective date of 1/1/21.

10/01/2020 R6

Under Article Text removed the word “two” and replaced it with “three” in the second sentence. Added the third bullet point and corresponding verbiage “Complications/disturbances of the circulatory system intra-operatively or postoperatively: I97.790, I97.791, I97.88 and I97.89.” Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added I97.790, I97.791, I97.88 and I97.89.

10/03/2019 R5

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles.

02/26/2018 R4 The Jurisdiction "J" Part B Contracts for Alabama (10112), Georgia (10212) and Tennessee (10312) are now being serviced by Palmetto GBA. Effective 02/26/18, these three contract numbers are being added to this article. No coverage, coding or other substantive changes (beyond the addition of the 3 Part B contract numbers) have been completed in this revision.
01/11/2018 R3

Annual Validation performed with no changes made.

01/05/2017 R2 Annual Validation performed-no changes made.
01/14/2016 R1 Under CPT/HCPCS Codes in the Paragraph section removed "Palmetto GBA" and added "the A/B MAC". Under CMS Manual Explanations URL(s) removed CMS Internet-Only Manuals, Publication 100-03, Ch. 1, §20.9 as that is not a valid reference.
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
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Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
02/23/2023 01/01/2023 - N/A Currently in Effect View
01/09/2023 01/01/2023 - N/A Superseded You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Percutaneous
  • PVAD