by Sandy Macica, MS, RHIA, CCS
The AHA Coding Clinic for ICD-10-CM and ICD-10-PCS, Second Quarter 2018, pg. 3, has provided clarification and further advice about the coding of an IABP. Information was originally published in Coding Clinic Third Quarter 2013. In First Quarter 2017, pg. 10, coding specialists were instructed that:
• Guidance for external heart assist devices do not apply to the placement or removal of intra-aortic balloon pumps therefore, it is not appropriate to report an IABP with the device value “external heart assist device.”
• Additionally, from a coding perspective, the IABP is not classified as a device, nor coded as a device in ICD-10-PCS.
• Since an IABP is not considered a device under ICD-10-PCS, it is also not appropriate to report the root operations “insertion” and/or “removal.”
This may still seem a little confusing due to the fact that the ICD-10-PCS definition of a device states: A device is coded only if a device remains after the procedure is completed. So, why is the IABP not a device if it is left in the body after surgery? First Quarter 2017 was referring to External Heart Assisted Devices, more specifically the Impella® device. The Impella® and IABP are two medical devices used to assist the heart pump to pump blood. Both devices push blood from the left ventricle to the aorta with each heartbeat. The major difference between the two devices is this:
• The IABP works by using the force of each heartbeat to increase blood flow and is attached to a computer console.
• The Impella® device functions independently of how forceful the heart beats.
The IABP is not considered a device because it is controlled by the console while the Impella® has an internal motor. Typically, auxiliary procedures done solely to support the performance of a surgical procedure are not coded separately. This guidance confirms that reporting cardiopulmonary bypass and IABP are exceptions. Intraoperative use of the IABP is reported with code 5A02210, Assistance with cardiac output using balloon pump, continuous. Since the IABP is not considered a “device,” this code is also used when the IABP is left in place following the procedure and subsequently removed at another time or if the patient arrives at another facility with the IABP in place and is removed at the transferred facility.
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