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This was very exciting, so whoever submitted this question, I really appreciated it because
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after I did the research, I didn’t know as much or hardly anything about this subject.
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I particularly like cardiology.
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Q: Can you review the LVAD/RVAD insertion codes for CV (cardiovascular) surgery?
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A: Actually, when I first looked at that, I thought, “Oh, my word, I don’t even
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know what a VAD is” and then it clicked as soon as I pulled it up. And then, “Oh,
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yes, I know what that is.”
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But, it is an assistive device, it’s a ventricular assist device, is what that stands for. And
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you can have a left and you can have a right, because you have a left and a right ventricle
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in your heart. Ultimately, what this is is it allows you to live a little longer when
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you need heart surgery.
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This first guy here, he is actually 20 years old, he was a professional athlete and he
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had a heart attack. So, you can see the surgery where they went in and I’m going to explain
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a little bit more how this is set up, but this was keeping him alive until he got a
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heart transplant.
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This is what it actually does, you have this device right here that goes into the aorta
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and then down into the ventricle. This one is going into the left ventricle so this would
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be an LVAD (left ventricular assist device). Then, there is this supply line and it literally
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is plugged into a motor and there’s a battery pack, you have to have two battery packs.
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You walk around with this everywhere you go, 24 hours a day. That literally keeps you going,
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literally keeps your heart going.
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This is called a “drive line.” It’s very important to know the drive line when
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you go to coding this, because there’s a lot of codes that surround the drive line
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and complications that can happen.
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Now, that we know what the VAD stands for, you have a left and right, you can also have
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a dual one which they call a BiVAD (bilateral, left and right ventricular assist device).
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There’s just kind of a smattering of codes to go with this and when you look at them,
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you want to always pay attention to the first term after your code. Now, keep in mind, this
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is a temporary device. I did read to see how long somebody has survived with one of these.
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I can’t remember, I think it said up to ten years somebody survived. Can you imagine?
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But, you eventually get taken off of the transplant list. This is temporary, it’s not meant
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to be long term. This is to keep you going until they can go in and do whatever repair
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needs to be done or replace the heart itself.
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The codes that the person was asking about were insertion codes. I went ahead and pulled
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out some of the other codes because they’re clumped in together. The first one, 33975
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is insertion of the ventricular assist device (which I’m just going to say VAD), extracorporeal,
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single ventricle. So, just one side that the left or the right ventricle is being done.
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Then you have insertion of a VAD for bothsides, left and right, 33976. Then, there are a couple
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of codes for removal of those devices that we just talked about. And then you have this
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33979 which is insertion of the VAD, implantable, intracorporeal, single ventricle. That’s
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where they’re doing something a little different. I’m going to explain that here in the future.
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Then, they have a removal code for that and then they have a replacement code for something
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going wrong and a part of the pump or something that needs to be replaced.
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{Ed. Note: correction: Let’s scroll down here, NOTE, very important about 33982 (which
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is without cardiopulmonary bypass): You’re not to use this -33982 - code with 33983 (which
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is with cardiopulmonary bypass.)]
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Now, there’s another replacement, not a big deal, easy to follow, some people get
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a little confused about what this extracorporeal mean, and it ultimately just means that it’s
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surgery. They’re doing something on the outside going in. So, intracorporealis going
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inside and doing and making any changes. But just think of it as surgery, that’s the
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best way to think of it.
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Don’t confuse interrogation with insertion – at first I thought, “Well, nobody will
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confuse that.” And then I got to looking at the codes, I thought, “Oh, I can see
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how this could be confusing.”So, this interrogation of the ventricular assist device (VAD), in
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person, with physician or other qualified healthcare professional… But, they’re
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talking about the driveline. Remember I told you about that driveline, that tube, all kinds
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of complications can happen with that. It can get infected.
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Think of somebody that has a stoma, we’re more familiar with stomas than we are of something
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being inserted directly into the heart and then them they’re using it all of the time.
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But infections can happen and injuries around that area where that driveline is going, you
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can have alarms and power surges. So, the review of device to function is part of it.
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They do flow and volume status, they do septum status and recovery. It’s amazing what they
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can plug these machines in and tell you about. Then, they’re doing programming and if that’s
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performed, they have reports and stuff.
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But do not report 93750 in conjunction with those other codes that we talked about at
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the top because this is something completely different, this interrogation is not the same
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as insertion or removal. This is just going in and maintaining, I guess is the best way
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to explain that. If you have not seen anything on this, absolutely do a little study.
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Real quick, I went ahead and pulled out because Find-A-Code has amazing, they call it “plain
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English interpretation” of what’s going on. I pulled this off of there. It said: “An
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in-person interrogation and evaluation of a ventricular assist device (VAD) with physician
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analysis, review, programming, and report is performed” – which we already said
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that.
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Then it goes on that it “may be performed on a routine basis or when the patient presents
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with symptoms or complaints that might be due to device malfunction or to a change in
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cardiac function” – so, once it’s inserted, it’s done. Then you’re going to start
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using this interrogation code unless they actually go and remove something or replace
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part of the devices. Again, keep those separate. The physician reviews interrogated data from
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the VAD function and the current programmed parameters and they can set it up to do what
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they want it to do. This is kind of like, it’s not really the same thing, but think
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of a pacemaker on steroids, this does a different function, but that’s mainly what it’s
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doing, it’s keeping that heart going. “Parameters analyzed include drivelines, alarms and power
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surges. Device function is evaluated for flow and volume status, septum, status and recovery.”
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Those are all the things that it assists with.
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Again, there are lots of reports that go along with this as you can imagine. One of the things
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I like to always mention in explaining some of these, you think, “Why don’t they just
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have one code that can take care of putting them in, taking them out, stuff like that.
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Why do they have to have multiple codes? Why do they do all this reporting and stuff?”
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Because you as a coder, what you do is based mainly on for statistical purposes; what you
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do now changes the future.
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This is an amazing device that I honestly don’t know how long it’s been around.
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I didn’t get that far into my research, but fascinating. When you have a little bit
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of time and you wanted to look up some stuff on the cardio, look into this, they even have
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lots of pictures on Google image on these actually being put in. I didn’t torture
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you with any of those tonight, but know that they do this for neonates all the way up to
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geriatric ages, all different ages. That’s it, guys, very exciting.