In the 2023 Fourth Quarter of the American Hospital Association (AHA) Coding Clinic, there is discussion of two types of short-term external heart assist systems. One is inserted through an incision into the ascending thoracic aorta or axillary artery and the other type is inserted percutaneously into the descending thoracic aorta.
The Impella 5.5 with Smart Assist System is a short-term method of treating cardiogenic shock that occurs within forty-eight hours of open-heart surgery or an acute myocardial infarction (AMI). This pump is inserted through an incision. When this code is assigned as the only procedure code, it is assigned to Medicare-Severity Diagnosis Groups (MS-DRG) 252-254 (Other Vascular Procedures) with relative weights ranging from 3.3538 to 1.7351. A code example would be X2HX0F9.
The other additions to Tables 02H (Insertion), 02P (Removal), and 02W (Revision) for the short-term heart assist system that is placed percutaneously. This pump is inserted into the descending thoracic aorta to treat decompensated congestive heart failure or acute on chronic congestive heart failure to relieve the heart of its workload. A code example would be 02HW3RZ. When this code is assigned alone, MS-DRG 215 (Other Heart Assist System Implant) is assigned with relative weight of 10.2148.
These procedures fall in the surgical hierarchy of MDC 05 (Circulatory System). Note that MS-DRG 215 is at the top of the hierarchy while MS-DRGs 252-254 fall at the lower end of the hierarchy.
It’s important to review cardiovascular procedure notes carefully for the use of this new technology for these procedure codes. The location of the pump and approach impact the MS-DRG significantly.
AHA’s Coding Clinic, Fourth Quarter 2023 ICD-10-CM/PCS MS-DRG v41.0 Definitions Manual: https://www.cms.gov/icd10m/FY2024-version41-fullcode-cms/fullcode_cms/P0384.html