Impella® External Heart Assist Device
The Impella® heart pump is a temporary ventricular support device designed to provide hemodynamic support to a patient with depressed heart function. The device is FDA approved for use in high-risk percutaneous coronary intervention and in instances where a patient is suffering from cardiogenic shock following a heart attack or an open heart surgery procedure. The Impella 2.5™ device is the world’s smallest heart pump. The whole device is less than the length of a pencil, and the pump is thinner than an eraser, allowing it to be placed into the heart through a peripheral artery. Once in place, the Impella devices pump blood for the left or right side of the heart, pumping blood into the ascending aorta or pulmonary artery, respectively. The Impella heart pump is designed to rest the patient’s heart during an elective or high-risk PCI procedure and prevents the heart from being overstressed by the procedure as coronary artery blockages are repaired. It also maintains blood flow and blood pressure during the procedure.
To properly code and report the use of Impella pumps coders must first determine when the device is inserted and removed in relation to any procedures. In some cases, only the code for Assistance (5A0) is reported and in others the insertion (02H) and/or removal (02P) must also be reported. The table below summarizes common clinical scenarios and the code(s) for the Impella device that would be reported.
| Scenario | Insertion | Assistance | Removal | Rationale |
| Impella pump is inserted in the Cath Lab at the start of procedure and removed at the completion of the procedure. | Not reported | 5A0221D – Assistance w/ cardiac output using Impeller Pump, Continuous | Not reported | Guideline B6.1a A device is coded only if a device remains after the procedure is completed. If no device remains, the device value No Device is coded. Currently there is no intermittent setting on an Impella device so the Duration value reported will be “Continuous”. (First Q 2017 P. 10 & 11) |
| Impella pump is inserted into the left ventricle in the Cath Lab at the start of procedure and left in at the completion of the procedure and removed at a later time. | 02HA3RZ – Insertion External Heart Assist System, Left Ventricle, Percutaneous | 5A0221D – Assistance w/ cardiac output using Impeller Pump, Continuous | 02PA3RZ – Removal External Heart Assist System, Percutaneous | When an external heart assist device is inserted during a procedure and is removed after the procedure is complete assign a code for both the Insertion and Removal as well as Assistance (First Q 2017 P. 11) |
| A right and left sided Impella pump is inserted in the Cath Lab at the start of procedure and the left sided device was removed at the completion of the procedure and the right sided device remained and is removed 3 days post-procedure | 02HA3RS – Insertion External Heart Assist System, Heart, Percutaneous | 5A0221D – Assistance w/ cardiac output using Impeller Pump, Continuous | 02PA3RZ – Removal External Heart Assist System, Percutaneous | Only the left sided device is removed at the end of the procedure therefore it is still classified as a device. (First Q 2017 P. 11-12) |
| Impella Pump in left ventricle is inserted in the Cath Lab at the start of procedure and left in at the completion of the procedure. The patient is transferred with the Impella devie still implanted. | 02HA3RZ – Insertion External Heart Assist System, Left Ventricle, Percutaneous | 5A0221D – Assistance w/ cardiac output using Impeller Pump, Continuous | Not reported | Since the pump remains in place at the conclusion of the procedure, but the patient is transferred before the device is removed only Insertion & Assistance are coded. |
| A patient is transferred into your facility with a left sided Impella device in place which is removed before the patient is discharged home. | Not reported | Not reported | 02PA3RZ Removal External Heart Assist System, Percutaneous | Only the code for the removal of the device should be reported. The code for Assistance is only reported when the initial insertion of an Impella pump occurs. (Fourth Q 2016 P. 137) |