Percutaneous Endovascular Cardiac Assist Procedures and Devices

Effective for dates of service on/after February 3, 2014.

Noridian will cover the percutaneous insertion of an endovascular cardiac assist device itself under limited conditions. Until the literature clearly demonstrates the efficacy of the treatment approach, coverage may be made only in the following two life-threatening situations and only when external counterpulsation (intraaortic balloon pump, IABP) is not expected to be sufficient; Cardiogenic shock or Severe decompensated heart failure with threatening multi-organ failure.

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

Coding Information

Bill Type Codes Description
078X Licensed Freestanding Emergency Medical Facility

 

Group 1: Paragraph
Part A Providers - Use ICD-10-PCS code 5A0221D
Part B Providers - Use CPT 33990 or 33991

Group 1: Codes

CPT Codes Description
33990 INSERTION OF VENTRICULAR ASSIST DEVICE, PERCUTANEOUS INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; ARTERIAL ACCESS ONLY
33991 INSERTION OF VENTRICULAR ASSIST DEVICE, PERCUTANEOUS INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; BOTH ARTERIAL AND VENOUS ACCESS, WITH TRANSSEPTAL PUNCTURE

 

ICD-10-CM Code Description
I97.0 Postcardiotomy syndrome
I97.710 Intraoperative cardiac arrest during cardiac surgery
I97.111 Intraoperative cardiac arrest during 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

 

Revision History

Date Brief Description
10/01/15 R4 - Changed ICD-10-PCS code from 02HL3DZ back to 5A0221D. Article number A52947 for JEA will be retired on 5/15/16. This article will be the same as Article number A52966 for JEB and combines both contract numbers for both JEA & JEB.
10/01/15 R3 - Revised to add 02HL3DZ in Keywords
10/01/15 R2 - Revised to add Cardiogenic shock or Severe decompensated heart failure with threatening multi-organ failure after the word sufficient and replaced the words "adhered to" to followed in the article text. Also changed the ICD-10-PCS from 5A0221D to 02HL3DZ.
10/01/15 R1 - Article revised to change ICD-10-CM procedure code from 02HL3DZ to ICD-10-PCS code 5A0221D.

 

Last Updated Thu, 25 Oct 2018 13:52:26 +0000