Cardiovascular Rounds

Recently announced coding change improves financial outlook for hemodynamic support devices

by Emily Fletcher

Annual coding adjustments are par for the course when it comes to CMS’s annual reimbursement updates. On rare occasions these changes can make a big difference in how hospitals are paid. This year, one such change caught our attention.

Recently the American Hospital Association released clarifying ICD-10 coding guidance that should shift hemodynamic support devices like Abiomed’s Impella device from valve MS-DRGs 216-218 to the higher reimbursed MS-DRG 215.

The somewhat unexpected change originated when the added specificity of ICD-10 coding revealed potential miscoding of percutaneous heart assist devices to lower-paying valve MS-DRGs under ICD-9.

Under ICD-10, coding for these devices requires both an insertion code and device code, which will assign it to MS-DRG 215 for “other heart system implant.” Specifically, the guidance calls for a code from table 02H that describes insertion of the device, and a code from table 5A0 that describes assistance with an impeller pump.

The change will likely lead to a significant shift of high-risk PCI and cardiogenic shock procedures with a percutaneous heart assist device to MS-DRG 215, which yields a significantly higher payment than the valve MS-DRGs, as outlined below:

FY 2017 payment by MS-DRG

Notably, MS-DRG 215 is not subject to a transfer penalty, which means that hospitals that implant an Impella device in a patient and then transfer that patient to another facility will receive full reimbursement for the care they provided. In such a case, the receiving hospital would code for assistance with an impeller pump.

Together, these changes are a boon for hub-and-spoke STEMI networks that treat cardiogenic shock patients.

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