Coding for resting percutaneous ventricular assist device (pVAD) repositioning without imaging guidance  

BACKGROUND:

The FDA has granted approval to market a pVAD device that uses hemodynamic guidance when device repositioning is needed. There is an existing code to report pVAD repositioning when the service is separate and distinct from insertion. However, the current pVAD repositioning code includes and requires imaging guidance be used for the repositioning procedure.

Q: How do I report pVAD repositioning (performed separately and distinctly from insertion) if only using hemodynamic guidance without imaging guidance?

A: For pVAD repositioning procedures that use only hemodynamic guidance without imaging guidance, modifier -52 indicating a reduced level of service must be appended to the pVAD repositioning code, 33993-52.

Q: How do I report pVAD repositioning (performed separately and distinctly from insertion) that uses hemodynamic guidance in addition to imaging guidance?

A: For pVAD repositioning procedures that use adjunctive imagine guidance in addition to hemodynamic guidance, the existing pVAD repositioning code, 33993 is applicable. 

Code descriptor for existing pVAD repositioning code-
33993 – Repositioning of percutaneous ventricular assist device with imaging guidance at separate and distinct session from insertion

Modifier 52-
52 Reduced Services: Under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. Under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service.

SCAI Real World Coding Scenarios

Scenario 1 - Patient is transferred to ICU with Impella and device becomes displaced, Physician does repositioning ONLY using SmartAssist.

Code: 33993-52

Scenario 2 - Patient is transferred to ICU with Impella and device becomes displaced, Physician does repositioning @ 10AM w/ SmartAssist & w/o imagine guidance, then confirms position is correct with ECHO at 3PM. 

Code: 33993-52 plus applicable echo code

Scenario 3 - Patient is transferred to ICU with Impella and device becomes displaced, Physician does repositioning @ 10AM w/ SmartAssist & w/o imagine guidance, then confirms position is incorrect with ECHO at 3PM and does reposition with ECHO.

Code: 33993-52 [recommended to note “10AM” in free form field]
Code: 33993 with modifier 59 or XE signifying a separate and distinct encounter [recommended to note “separate and distinct encounter 3PM” in free form field]

Disclaimer: The ACC and SCAI are committed to making every reasonable effort to provide accurate information regarding the use of CPT^®, and the rules and regulations set forth by CMS for the Medicare program. However, this information is subject to change by CMS and does not dictate coverage and reimbursement policy as determined by local Medicare contractors or any other payor. ACC and SCAI assume no liability, legal, financial, or otherwise, for physicians or other entities who utilize this information in a manner inconsistent with the policies of any payors or Medicare carriers with which the physician or other entity has a contractual obligation. CPT codes and their descriptors are copyright 2018 by the American Medical Association.