Reimbursement, AMI Cardiogenic Shock, Protected PCI

Increasing Your Healthcare Economics IQ


Rick Clark, CPC, CPMA, manager of field reimbursement at Abiomed, discusses hospital reimbursement, provider reimbursement, and documentation best practices at this educational event for advanced practice providers (APPs). He explains that this presentation focusses on sustainability, namely, “How do we make sure we can sustain these programs long-term?” 

Rick begins with a summary of hospital reimbursement for Impella, reiterating that Impella® is an inpatient-only procedure and therefore reimbursement is grouped under a diagnosis-related group (DRG). He emphasizes, “We do want to make sure that we admit our patients 100% of the time.” Our reimbursement really comes down to 2 things, he tells the audience: “How did the device go in the patient’s body? And when was the device removed?”

After briefly reviewing hospital transfer scenarios, Rick focuses on provider coding and billing. “One of the things that kind of differentiates Impella versus maybe some of your other cath lab procedures, or your structural heart procedures, is Impella truly is an unbundled service,” he explains. “You are able to bill separately for all the various portions of the procedure on top of the actual intervention, the PCI the stenting, the atherectomy, etc.” He shows current procedural terminology (CPT) codes for left and right percutaneous insertion, axillary cutdown, percutaneous removal, repositioning, critical care monitoring, and device management. He then reviews proper documentation and charge capture for cardiogenic shock and high-risk Protected PCI.

Rick also covers a few frequently asked questions:

  • “Can an APP admit the patient as an inpatient?”
  • “What is ‘split/shared’ and how does it govern charging for a visit when both the physician and APP are involved?”
  • “Can an APP perform critical care?”
  • “Can the physician bill for a procedure that is performed by an APP on a Medicare patient?”
  • “When an APP performs an independent service must the physician also sign the chart, or can the service be billed with only the APP’s signature?”

He wraps up by presenting the cost effectiveness of Protected PCI with reduced length of stay and fewer readmissions from repeat procedures. He then highlights the weekly Wednesday Webinar that takes a deep dive into coding, as well as other helpful resources including an Impella Reimbursement Guide, Clinical Documentation Guide, Common MCC/CC List, and Cardiac Cath Lab ICD-10 Codes.

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