LCD Reference Article Billing and Coding Article

Billing and Coding: Percutaneous Ventricular Assist Device

A53988

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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.
NOT AN LCD REFERENCE ARTICLE
This article is not in direct support of an LCD.

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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A53988
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

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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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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.

Response To Comments

Number Comment Response
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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

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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

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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

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Group 1 Codes

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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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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

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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

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Other Coding Information

Group 1

Group 1 Paragraph

Part A Providers: ICD-10-PCS codes

Group 1 Codes
Code Description
5A02116
5A0211D
5A02216
5A0221D
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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
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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 R10

Under CPT/HCPCS Codes Group 1: Codes deleted M1151 and M1152 as these codes were added in error. This revision is retroactive effective for dates of service on or after 1/1/23.

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.
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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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Public Versions
Updated On Effective Dates Status
02/23/2023 01/01/2023 - N/A Currently in Effect You are here
01/09/2023 01/01/2023 - 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