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New FY22 Code: Coronary Intravascular Lithotripsy (IVL)

Currently, there is no unique ICD-10-PCS code to identify the use of intravascular lithotripsy (IVL) to treat calcified lesions in the coronary arteries. Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation is the most frequent mode of coronary revascularization. Advanced age and an increasing frequency of diabetes mellitus, hypertension, and renal insufficiency contribute to an increasing prevalence and severity of vascular calcification. PCI of heavily calcified lesions may be associated with early complications such as dissection, perforation, and/or myocardial infarction. Late adverse effects include restenosis, stent fracture, thrombosis and/or need for repeat revascularization.

Coronary intravascular lithotripsy (IVL) is a new treatment option for treating calcified lesions in the coronary arteries. Coronary IVL utilizes controlled sound waves in short pulses to selectively crack intimal and medial calcium within the vessel wall without affecting soft tissue. Once fractured, the calcium’s resistance to balloon dilatation is reduced, thereby allowing the blood vessel to be dilated using a low-pressure angioplasty balloon prior to coronary stenting. The coronary IVL catheter is advanced to the target lesion and the integrated balloon is inflated with fluid at a low pressure to contact the arterial wall. Coronary IVL is then activated, creating a small bubble within the catheter balloon that rapidly expands and collapses. The rapid expansion and collapse of the bubble creates sonic pressure waves that travel through the innermost layer of the vessel wall and crack the calcium within the vessel wall. FDA approval for the coronary IVL is expected in early 2021 and a New Technology Add-on Payment (NTAP) application for FY 2022 consideration.

Effective October 1, 2021 Table 02F will be revised to include body part characters for coronary arteries. Coders should separately assign the applicable ICD-10-PCS code(s) for angioplasty or stent insertion if performed.

Section             0 Medical and Surgical

Body System  2 Heart and Great Vessels

Operation        F Fragmentation: Breaking solid matter in a body part into pieces

Body PartApproachDeviceQualifier
0 Coronary Artery, One Artery
1 Coronary Artery, Two Arteries
2 Coronary Artery, Three Arteries
3 Coronary Artery, Four or More Arteries
3 PercutaneousZ No DeviceZ No Qualifier