Superseded Local Coverage Article Billing and Coding

Billing and Coding: Percutaneous Ventricular Assist Device

A53988

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Contractor Information

Article Information

General Information

Article ID
A53988
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
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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.

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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 (intraaortic 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.

Part A Providers: ICD-10-PCS codes:

  • 5A02116 - Assistance with Cardiac Output using Other Pump, Intermittent
  • 5A0211D -Assistance with Cardiac Output using Impeller Pump, Intermittent
  • 5A02216 - Assistance with Cardiac Output using Other Pump, Continuous
  • 5A0221D - Assistance with Cardiac Output using Impeller Pump, Continuous

For Part A Services only, the provider should bill the appropriate procedure code on the UB-04 as this is an inpatient only procedure.

Coding Information

CPT/HCPCS Codes

Group 1

(8 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
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)

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(13 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
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

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

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.

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.

N/A

Other Coding Information

Group 1

Group 1 Paragraph

Part A Providers: ICD-10-PCS codes

Group 1 Codes
Code
5A02116
5A0211D
5A02216
5A0221D

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/01/2023 R9

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.

01/01/2021 R8

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.” 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-CM Codes that Support Medical Necessity Group 1: Codes added I97.790, I97.791, I97.88 and I97.89. This revision is retroactive effective for dates of service on or after 10/1/2020.

01/01/2021 R7

Under CPT/HCPCS Codes Group 1: Codes added 33990, 33991, 33992, and 33993. This revision is retroactive effective for dates of service on or after 3/4/2020.

01/01/2021 R6

Under CPT/HCPCS Codes Group 1: Codes added codes 33995 and 33997. This revision is due to the Q1 2021 CPT/HCPCS code update and has a retroactive effective date of 1/1/21.

10/10/2019 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. Under Article Title changed the title from “Percutaneous Ventricular Assist Device” to “Billing and Coding: Percutaneous Ventricular Assist Device”. Under Other Coding Information: Group 1: Paragraph added the verbiage “Part A Providers: ICD-10-PCS codes”. Under Other Coding Information: Group 1: Codes added the codes 5A02116, 5A0211D, 5A02216 and 5A0221D.

02/26/2018 R4 The Jurisdiction "J" Part A Contracts for Alabama (10111), Georgia (10211) and Tennessee (10311) 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 A contract numbers) have been completed in this revision.
06/08/2017 R3

Under Article Text in the first sentence deleted “itself”.

06/23/2016 R2 Under Statutory Requirements URL(s) deleted the url as the page was not found.
10/01/2015 R1 Under Article Text- ICD-10-PCS Codes corrected the code description for 5A0211D. Under Article Text in the last sentence removed the referenced bill type. Per CMS Internet-Only Manual, Pub 100-08, Medicare Program Integrity Manual, Chapter 13, §13.1.3 LCDs consist of only “reasonable and necessary” information. All bill type and revenue codes have been removed from the LCDs. For consistency, they are also being removed from the articles. Under CMS Manual Explanations URL(s) removed the referenced url.

Associated Documents

Related Local Coverage Documents
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Related National Coverage Documents
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Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
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
10/28/2021 01/01/2021 - 12/31/2022 Superseded View
02/25/2021 01/01/2021 - N/A Superseded View
02/05/2021 01/01/2021 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • PVAD
  • Percutaneous Ventricular Assist Device