Patient Management, Reimbursement, Protected PCI

Can I Bill for Daily Management of Impella®?

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Question: Are there billable services after Impella® insertion in the cath lab, such as ICU monitoring?

Answer: Yes, with medical documentation and specific requirements we will discuss below. The most common are critical care E&M codes (CPT 99291-2), repositioning after leaving the cath lab (CPT 33993), and removal in a separate session (CPT 33992).

When a patient is being cared for in the ICU (post-Impella insertion, CPT Code 33990), the critical care Evaluation and Management Codes can be used. These codes are "time based codes" : CPT Codes 99291-99292 are used to report the total duration of time spent in provision of critical care services to a critically ill patient, even if the time spent on that date is not continuous. CPT Code 99291 is used to report the first 30-74 minutes of critical care on a given date. It should be used only once per date even if the time spent by the individual is not continuous on that date. CPT Code 99292 is used to report additional blocks of time, of up to 30 minutes each beyond the first 74 minutes.

Time spent with the individual patient should be recorded in the patient's record (usually in the progress note). The time that can be reported as critical care is the time spent engaged in work related to the individual patient's care whether that time was spent at the bedside, or in conversation with family or other consultants related to patient management. While these are not only for Impella® procedures, the criteria for use of hemodynamic support are of the complexity required for this higher level daily care fee.

Any repositioning of the Impella® device that occurs in the ICU (with documentation of imaging guidance) can also be coded and billed using CPT 33993. Cardiogenic Shock patients with ongoing Impella® support require close monitoring and frequently benefit from decision making regarding mechanical circulatory support evaluation, weaning, escalation, and drip management. If a patient remains on support beyond the original cath lab procedure, the removal of the device can also be coded and billed using CPT 33992. This is only in the case removal in a separate session and is not available if done during the same session as the device is inserted.

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