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Coding Tip of the Month – January 2017


A patient is admitted to University Hospital in cardiogenic shock due to an acute LAD blockage. The patient was taken to the cath lab where 2 lesions were found. One, in the proximal LAD, was stented with a single DES and in the distal lesion 2 kissing DES were deployed. Following the PTCA a 2.5 Impella® pump was inserted in the left ventricle via the femoral artery. The patient is transferred to Community Hospital for further recovery and on the fourth hospital day the patient is taken to Cath Lab and the device was removed. What are the PCS code(s) for University Hospital and Community Hospital?


University Hospital

027036Z – Dilation of 1 coronary artery, 3 Drug Eluting Stents, Percutaneous

02HA3RZ – Insertion into Heart, External Heart Assist System, Percutaneous

5A0221D – Assistance with Cardiac Output using Impeller Pump, Continuous

Community Hospital

02PA3RZ – Removal of External Heart Assist System from Heart, Percutaneous


Coding Clinic, Fourth Q P. 137

Impella® 2.5 is a minimally invasive, percutaneous catheter-based hemodynamic support devices, designed to provide partial circulatory support and reduce the workload of the heart. When a patient is admitted and has an Impella® device inserted two codes should be reported:

  • A code from 02H that describes the insertion of the device and a code from;
  • Table 5A0 that describes assistance with an Impeller pump

If a patient is subsequently transferred with the Impella® device still in place, the only code reported by the second facility is a code for the removal of the device if the device is removed.

Coding advice and guidelines regarding reporting Impella® devices continue to undergo revision and refinement so facilities reporting this procedure must watch for ongoing updates. Early PCS version classified Impella® devices as intraluminal devices and the Coding Clinic, Third Q 2014 provides an example of an Impella® device where only code for the root operation “Assistance” is assigned. Current Coding and Billing Guides provided by Impella® manufacturers may not be current with the coding advice in the Fourth Quarter 2016 Coding Clinic.

ICD-10 PCS procedure code 5A0221D (Assistance with Cardiac Output using Impeller Pump, Continuous) is used in DRG logic for the DRG assignment rather than the code for “Insertion”.

Impeller Code With Cardiac Catheterization MS-DRG Assignment

Assistance with Cardiac Output using Impeller Pump, Continuous

Yes 216 (With MCC)

217 (With CC)

218 (Without MCC/CC)


Assistance with Cardiac Output using Impeller Pump, Continuous

No 219 (With MCC)

220 (With CC)

221 (Without MCC/CC)

For encounters where the Impella® Device is removed the DRG assignment will be DRG 268 or DRG 269.