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  • This was very exciting, so whoever submitted this question, I really appreciated it because

  • after I did the research, I didn’t know as much or hardly anything about this subject.

  • I particularly like cardiology.

  • Q: Can you review the LVAD/RVAD insertion codes for CV (cardiovascular) surgery?

  • A: Actually, when I first looked at that, I thought, “Oh, my word, I don’t even

  • know what a VAD isand then it clicked as soon as I pulled it up. And then, “Oh,

  • yes, I know what that is.”

  • But, it is an assistive device, it’s a ventricular assist device, is what that stands for. And

  • you can have a left and you can have a right, because you have a left and a right ventricle

  • in your heart. Ultimately, what this is is it allows you to live a little longer when

  • you need heart surgery.

  • This first guy here, he is actually 20 years old, he was a professional athlete and he

  • had a heart attack. So, you can see the surgery where they went in and I’m going to explain

  • a little bit more how this is set up, but this was keeping him alive until he got a

  • heart transplant.

  • This is what it actually does, you have this device right here that goes into the aorta

  • and then down into the ventricle. This one is going into the left ventricle so this would

  • be an LVAD (left ventricular assist device). Then, there is this supply line and it literally

  • is plugged into a motor and there’s a battery pack, you have to have two battery packs.

  • You walk around with this everywhere you go, 24 hours a day. That literally keeps you going,

  • literally keeps your heart going.

  • This is called a “drive line.” It’s very important to know the drive line when

  • you go to coding this, because there’s a lot of codes that surround the drive line

  • and complications that can happen.

  • Now, that we know what the VAD stands for, you have a left and right, you can also have

  • a dual one which they call a BiVAD (bilateral, left and right ventricular assist device).

  • There’s just kind of a smattering of codes to go with this and when you look at them,

  • you want to always pay attention to the first term after your code. Now, keep in mind, this

  • is a temporary device. I did read to see how long somebody has survived with one of these.

  • I can’t remember, I think it said up to ten years somebody survived. Can you imagine?

  • But, you eventually get taken off of the transplant list. This is temporary, it’s not meant

  • to be long term. This is to keep you going until they can go in and do whatever repair

  • needs to be done or replace the heart itself.

  • The codes that the person was asking about were insertion codes. I went ahead and pulled

  • out some of the other codes because theyre clumped in together. The first one, 33975

  • is insertion of the ventricular assist device (which I’m just going to say VAD), extracorporeal,

  • single ventricle. So, just one side that the left or the right ventricle is being done.

  • Then you have insertion of a VAD for bothsides, left and right, 33976. Then, there are a couple

  • of codes for removal of those devices that we just talked about. And then you have this

  • 33979 which is insertion of the VAD, implantable, intracorporeal, single ventricle. That’s

  • where theyre doing something a little different. I’m going to explain that here in the future.

  • Then, they have a removal code for that and then they have a replacement code for something

  • going wrong and a part of the pump or something that needs to be replaced.

  • {Ed. Note: correction: Let’s scroll down here, NOTE, very important about 33982 (which

  • is without cardiopulmonary bypass): Youre not to use this -33982 - code with 33983 (which

  • is with cardiopulmonary bypass.)]

  • Now, there’s another replacement, not a big deal, easy to follow, some people get

  • a little confused about what this extracorporeal mean, and it ultimately just means that it’s

  • surgery. Theyre doing something on the outside going in. So, intracorporealis going

  • inside and doing and making any changes. But just think of it as surgery, that’s the

  • best way to think of it.

  • Don’t confuse interrogation with insertionat first I thought, “Well, nobody will

  • confuse that.” And then I got to looking at the codes, I thought, “Oh, I can see

  • how this could be confusing.”So, this interrogation of the ventricular assist device (VAD), in

  • person, with physician or other qualified healthcare professionalBut, theyre

  • talking about the driveline. Remember I told you about that driveline, that tube, all kinds

  • of complications can happen with that. It can get infected.

  • Think of somebody that has a stoma, were more familiar with stomas than we are of something

  • being inserted directly into the heart and then them theyre using it all of the time.

  • But infections can happen and injuries around that area where that driveline is going, you

  • can have alarms and power surges. So, the review of device to function is part of it.

  • They do flow and volume status, they do septum status and recovery. It’s amazing what they

  • can plug these machines in and tell you about. Then, theyre doing programming and if that’s

  • performed, they have reports and stuff.

  • But do not report 93750 in conjunction with those other codes that we talked about at

  • the top because this is something completely different, this interrogation is not the same

  • as insertion or removal. This is just going in and maintaining, I guess is the best way

  • to explain that. If you have not seen anything on this, absolutely do a little study.

  • Real quick, I went ahead and pulled out because Find-A-Code has amazing, they call itplain

  • English interpretationof what’s going on. I pulled this off of there. It said: “An

  • in-person interrogation and evaluation of a ventricular assist device (VAD) with physician

  • analysis, review, programming, and report is performed” – which we already said

  • that.

  • Then it goes on that itmay be performed on a routine basis or when the patient presents

  • with symptoms or complaints that might be due to device malfunction or to a change in

  • cardiac function” – so, once it’s inserted, it’s done. Then youre going to start

  • using this interrogation code unless they actually go and remove something or replace

  • part of the devices. Again, keep those separate. The physician reviews interrogated data from

  • the VAD function and the current programmed parameters and they can set it up to do what

  • they want it to do. This is kind of like, it’s not really the same thing, but think

  • of a pacemaker on steroids, this does a different function, but that’s mainly what it’s

  • doing, it’s keeping that heart going. “Parameters analyzed include drivelines, alarms and power

  • surges. Device function is evaluated for flow and volume status, septum, status and recovery.”

  • Those are all the things that it assists with.

  • Again, there are lots of reports that go along with this as you can imagine. One of the things

  • I like to always mention in explaining some of these, you think, “Why don’t they just

  • have one code that can take care of putting them in, taking them out, stuff like that.

  • Why do they have to have multiple codes? Why do they do all this reporting and stuff?”

  • Because you as a coder, what you do is based mainly on for statistical purposes; what you

  • do now changes the future.

  • This is an amazing device that I honestly don’t know how long it’s been around.

  • I didn’t get that far into my research, but fascinating. When you have a little bit

  • of time and you wanted to look up some stuff on the cardio, look into this, they even have

  • lots of pictures on Google image on these actually being put in. I didn’t torture

  • you with any of those tonight, but know that they do this for neonates all the way up to

  • geriatric ages, all different ages. That’s it, guys, very exciting.

This was very exciting, so whoever submitted this question, I really appreciated it because

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B1 US insertion device ventricle interrogation assist surgery

Review of LVAD RVAD Insertion Codes | Medical Coding Training

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    Ting Huang posted on 2016/05/17
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