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.
|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
|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|
|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|
|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 Oct 25, 2018