Question:

What code should we report for the insertion of a percutaneous ventricular-assist device such as the Impella device?

Answer:

The following four codes exist for the insertion, removal and repositioning of a percutaneously inserted ventricular assist device (pVAD):

33990 Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; arterial access only
33991 both arterial and venous access, with transseptal puncture
33992 Removal of percutaneous ventricular assist device at separate and distinct session from insertion
33993 Repositioning of percutaneous ventricular assist device with imaging guidance at separate and distinct session from insertion

Code 33990 is assigned for devices such as Impella 2.5 and Impella 5.0, which require arterial access only. Insertion of the TandemHeart and other devices that require both arterial and venous access would be coded 33991. Repositioning of either type of device at a separate session would be coded 33993. Removal of either type of device at a separate session would be coded 33992.

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