A ventricular assist device(also referred to as a VAD) is a mechanical device that assists the heart when the heart is too weak to adequately circulate blood to the body. These devices may be used to temporarily support a patient whose heart is failing due to injury or illness. They are also sometimes used to help support a patient’s failing heart until the patient can have a heart transplant (in notes the physician may refer to this as a “bridge to transplant”).
The ventricles of the heart are the natural “pumps” in the heart. The right ventricle pumps blood through the pulmonary artery and into the lungs to receive a fresh supply of oxygen while the left ventricle pumps blood out of the heart and into the aorta where it can circulate to the rest of the body. When one of the heart’s natural pumps fail, this can cause serious health problems and even death if left untreated.
A VAD can be placed to support the left ventricle, the right ventricle, or both. A VAD placed to support the left ventricle is sometimes referred to as an LVAD for short while a VAD placed to support the right ventricle is sometimes referred to as an RVAD for short. A VAD placed to support both ventricles of the heart is sometimes referred to as a biventricular VAD or a BIVAD for short.
There are different types of VADs that can be implanted depending on the patient’s condition and the amount of time the patient is expected to need support from the VAD.
- A percutaneous VADis one inserted through a catheter placed into an artery and/or vein and then threaded through to the heart. An example of a percutaneous VAD is an Impella device. This device is often placed by cardiologists or interventional radiologists due to the minimally invasive approach needed to insert the device.
- Anextracorporeal VADis inserted through a more invasive open approach. The surgeon creates a sternotomy or a thoracotomy and inserts what are called “cannulas” (tubes that allow the blood to flow out of the body and into the VAD which then helps to circulate blood back into and through the entire body). The pump of the VAD which is the part of the device that helps to pump and circulate the blood is located outside of the body. If we break down the word extracorporeal, extra means “outside” and corporeal refers to “the body” so the extracorporeal VAD is a VAD whose pump is outside the body. An example of an extracorporeal VAD is a Centrimag VAD.
- Anintracorporeal VADis inserted through a more invasive open approach as well. The surgeon creates a sternotomy or a thoracotomy and inserts cannulas just like the extracorporeal VAD, but the pump of the VAD which is the part of the device that helps to pump and circulate the blood is located inside the body. If we break down the word intracorporeal, intra means “inside” or “within” and corporeal refers to “the body” so the intracorporeal VAD is a VAD whose pump is placed inside the body. Depending on the type of VAD inserted, this pump may be in the chest cavity right alongside the heart, embedded in the pericardium, or implanted in a subcutaneous pocket in the abdominal wall. Examples of common intracorporeal VADs are the Heart Mate II, the Heart Mate III, and the Heart Ware device.
There are different CPT codes for inserting and removing the different types of VADs listed above. In some cases, there are codes for repositioning or replacing parts of the device as well. Let’s take a look at the different codes available for each device.
- The CPT codes forinsertingapercutaneous VADare CPT codes 33990 or 33991. CPT 33990 is coded when an artery is accessed to place the VAD. CPT 33991 is coded when both an artery and a vein are accessed to place the VAD. CPT 33991 also includes a transseptal puncture “when performed.” This means you may still code CPT 33991 if both an artery and vein are accessed to place the VAD and no transseptal puncture is required, but you should not add a code like CPT 93462 to report a transseptal puncture when one is required since this work is already included in CPT 33991.
- The CPT code forremovingapercutaneous VADis CPT 33992. This one code is used to report the removal of the percutaneous VAD whether or not it was originally inserted through an artery only or through an artery and a vein.
- The CPT code forrepositioningapercutaneous VADis CPT 33993. This code may be reported anytime the VAD is repositioned other than the same surgery when it is inserted (any repositioning necessary during the initial insertion of the device is considered part of CPT 33990 or 33991 and is not reported separately).
- The CPT codes forinsertinganextracorporeal VADare CPT codes 33975 and 33976. CPT 33975 is coded if a VAD supporting only one of the ventricles is inserted while CPT 33976 is coded if a VAD supporting both ventricles is inserted.
- The CPT codes forremovinganextracorporeal VADare CPT codes 33977 and 33978. Just like the insertion codes, CPT code 33977 is coded for removal of a VAD supporting only one of the ventricles while CPT 33978 is coded for removal of a VAD supporting both ventricles.
- There isno codeforrepositioningan extracorporeal VAD. If the cannulas of an extracorporeal VAD are repositioned, code unlisted CPT 33999.
- There is alsono codeforreplacingan entire extracorporeal VAD. CPT 33981 reports replacement of the extracorporeal VAD pump only. This code may be used to report replacement of one or more pumps for a single ventricle or biventricular VAD. When the entire VAD is replaced, though (both pump and cannulas), code the new insertion code only per CPT guidelines. These guidelines instruct us tonotassign an additional code for removal of the old VAD. Example: Ifa Centrimag LVAD pump and cannulas were removed and a new extracorporeal LVAD with pump and cannulas was inserted during a single surgery, you would report only CPT 33975. Do not code 33977 in addition to CPT 33975 per CPT guidelines.
- The CPT code forinsertinganintracorporeal VADis CPT 33979. Unlike extracorporeal VADs, we do not have two different CPT codes to report devices that support a single ventricle vs those that support both ventricles. CPT 33979 is written for a “single ventricle” device. Intracorporeal VADs are most often placed to support only one ventricle, but in very sick patients, particularly those waiting for transplants, you may see an intracorporeal LVAD placed followed by an intracorporeal RVAD. If intracorporeal VADs are placed to support both ventricles, report CPT 33979 and then 33979 again with modifier 59 to represent the two devices inserted.
- The CPT code forremovinganintracorporeal VADis CPT 33980. Again this code represents removal of a “single ventricle” device. If a patient had an intracorporeal RVAD and an LVAD and both devices were removed during the same surgery, you would report CPT 33980 and then CPT 33980 again with modifier 59 to report the removal of both devices.
- There isno codeforrepositioning an intracorporeal VAD.If the cannulas or the pump of an intracorporeal VAD are repositioned, code unlisted CPT 33999.
- There is alsono codeforreplacinganentire intracorporeal VAD.CPT 33982 reportsreplacementof theintracorporealVADpump only.This code may be used to report replacement of one or more pumps for an intracoporeal VAD. When the entire VAD is replaced, though (both pump and cannulas), code the new insertion code only per CPT guidelines. These guidelines instruct us tonotassign an additional code for removal of the old VAD. Example:If a Heart Mate II RVAD pump and cannulas were removed and a new intracorporeal RVAD with pump and cannulas was inserted during a single surgery, you would report only CPT 33979. Do not code 33980 in addition to 33979 per CPT guidelines.
Now that we have discussed the different types of VADs and the CPT codes for reporting insertion, removal, and repositioning, let’s take a look at a couple of examples and see if we can identify the correct codes together.
Example #1:After sterile prep and drape, a median sternotomy was created. An aortic cannula and venous cannula were placed and the patient was converted onto cardiopulmonary bypass. After ensuring the patient was stable on bypass, a Hemashield graft was sewn onto the aorta. The venous cannula was then inserted and both cannulas were then connected to a Heart Mate II pump. A subcutaneous pocket was fashioned in the abdominal wall and the pump was inserted. The driveline was tunneled to exit the abdominal wall and connected to power.Patient was weaned off bypass and the LVAD was determined to be functioning appropriately. Patient was taken to the ICU in critical but stable condition.
The underlined portions of the description are keys to picking the correct CPT code. We first see the approach (a median sternotomy). Based on this detail alone, we can rule out CPT codes for a percutaneous VAD because the physician is using an invasive approach into the chest. We then see the surgeon placing a graft onto the aorta (which is placement of an aortic cannula) followed by placement of a venous cannula. Then we see the cannulas being connected to the pump and a trade name of Heart Mate II. The pump is then inserted into a pocket in the abdominal wall. Because the pump is implanted in the body in the abdominal wall, this is an intracorporeal VAD. Even if the trade name Heart Mate II (which again is a common intracorporeal VAD) were missing from this note, the fact that the pump was implanted in the abdominal wall would tell us the pump was intracorporeal (or inside the body). Our final clue that the pump is in the body is that a “driveline” (which is a power cord) is tunneled from the pump in the body, through the abdominal wall, and ultimately connected to a power source outside the body. Since the physician in this case is inserting an intracorporeal VAD, we would code CPT 33979 for this example.
Example #2:After sterile prep and drape, previous left thoracotomy was re-opened and rib spreaders were used to enter the chest. The Centrimag RVAD pump was then powered off and the arterial and venous cannulas were dissected free and completely removed. Hemostasis was ensured. The chest wall was then closed in layers and the patient left the OR in stable condition.
The underlined portions of the description are keys to picking the correct CPT code. We first see the approach (a left thoracotomy). Based on this detail alone, we can rule out CPT codes for a percutaneous VAD because the physician is using an invasive approach into the chest. Next we see the trade name “Centrimag”(which again is a common extracorporeal VAD) and the fact that the pump is being turned off. Next we see that the patient has an RVAD device (a single ventricle device supporting a failing right ventricle). Then we see cannulas being “removed.” All of these details add up removal of an extracorporeal VAD supporting a single ventricleor CPT 33977.
In conclusion, when deciding which CPT code to report for a VAD, focus on the approach (percutaneous, sternotomy, or thoracotomy), what is being performed (insertion, removal, or repositioning), where the pump is located (inside or outside of the body), and whether one or both ventricles is being supported by the VAD device to decide which code is best for your particular case.
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The two basic types of VADs are a left ventricular assist device (LVAD) and a right ventricular assist device (RVAD). If both types are used at the same time, they may be called a biventricular assist device (BIVAD). However, a BIVAD isn't a separate type of VAD. The LVAD is the most common type.What is the most common type of ventricular assist device? ›
Left ventricular assist device (LVAD) is the most common. It helps the left side of your heart pump oxygen-rich blood from the heart out to your body. Right ventricular assist device (RVAD) pumps oxygen-poor blood from the right side of your heart to your lungs.How long can you have a ventricular assist device? ›
Q: How long does the LVAD last? A: The longest device has been in a patient for about 7 years. Testing by the manufacturers suggests that the LVAD should provide support for at least 10 years.What is the difference between Impella and LVAD? ›
What is Impella? Impella Ventricular Support System is a small Left Ventricular Assist Device (LVAD). It is designed to help pump blood in patients who require short term support. The device is a tiny pump inside of a catheter with an electric motor that can deliver about 2.5 liters of blood per minute to the body.What is the difference between a VAD and a LVAD? ›
Another name for a VAD is a durable mechanical circulatory support device. A VAD is most frequently placed in the left lower heart chamber, called the left ventricle. When placed in the left ventricle, it's called a left ventricular assist device (LVAD).Is an Impella a VAD? ›
Another type of paracorporeal VAD, called the Impella 2.5 Cardiac Assist Device, has a very small pump located on the tip of a catheter.What is the newest LVAD device? ›
HeartMate 3 LVAD
The HeartMate 3 is the newest type of LVAD that the FDA has approved. It is a small centrifugal pump that uses a fully magnetically rotor to reduce blood cell breakdown.
The Impella device is a catheter-based miniaturized ventricular assist device that pumps blood from left ventricle (LV) into ascending aorta and responsible for systemic circulation at an upper rate between 2.5 and 5.0 L/min.Is a VAD the same as a pacemaker? ›
The function of a VAD differs from that of an artificial cardiac pacemaker in that a VAD pumps blood, whereas a pacemaker delivers electrical impulses to the heart muscle.Can you feel a pulse with an LVAD? ›
The use of pulse and blood pressure to assess stability can be unreliable in an LVAD patient, even if they are very stable. 6. VITALS: a. Pulse: Generally you will be unable to feel a pulse.
Compared with a pacemaker
An LVAD and a pacemaker serve different purposes. While an LVAD helps the heart pump blood effectively, a pacemaker helps correct an irregular or slow heartbeat. It does not help with pumping — instead, a pacemaker generates electrical stimulation that regulates the heartbeat.
Left Ventricular Assist Devices (LVADs) A left ventricular assist device (LVAD) helps your heart pump better when you have heart failure. Some people use this device while waiting for a heart transplant.What is the longest a person has lived with an LVAD? ›
At age 84, Gayle, holds the honor of living on a left ventricular assist device (LVAD) for 10 years. Those odds don't always work that kind of wonder for many – only a few patients in the U.S. have achieved that milestone.What is the leading cause of death for LVAD patients? ›
Neurologic events remain one of the most dreaded complications of LVAD support and are most often the primary cause of death .Can you walk with Impella? ›
Depending on your overall condition, you may be able to walk short distances in the hospital with the Impella in place. When your heart recovers, or when you're ready to move to longer-term support like ECMO or an LVAD, your cardiologist will remove the Impella through the same incision used to place it.How long can an Impella device stay in? ›
The Impella was successfully inserted in all cases with a median duration of support of 70 minutes (range, 4 - 5760 minutes).How long can a patient be on Impella? ›
Impella CP, 5.0 and RP belong to the group of short-term mechanical circulatory support (MCS) devices used for patients with severe heart failure and cardiogenic shock. The Impella is designed for short-term support up to 10 days, but our patients frequently require a longer duration of support.Can you go home with a VAD? ›
Absolutely! Once your chest is healed, your vital signs have improved and the LVAD is working optimally without any issues, you may travel like anyone else.Do you do CPR with LVAD? ›
According to the AHA scientific statement, if LVAD is non-functioning or LVAD functioning with mean arterial pressure < 50mmHg or EtCO2 < 20 mmHg, chest compression are recommended, though safety and efficacy of chest compression is not established.What happens if an LVAD suddenly loses power? ›
Most often when a LVAD is turned off the patient dies within minutes. However, if there is intrinsic heart function the patient may live for several days.
The Impella® blood pump is inserted into the femoral artery through a small incision in the leg. The Impella® blood pump can also be inserted into the subclavian artery through a small incision in the chest. Then it is advanced through the patient's artery to their heart.Do you do CPR with Impella? ›
3 - CPR DURING IMPELLA SUPPORT
CPR should be performed based on loss of perfusion pressure and/or flow, rather than on electrocardiogram or flattening of the arterial waveform, since the device can often main- tain adequate perfusion pressures despite ventricular tachycardia.
ECMO is a temporary fix that is usually used only for a few days. If longer support is needed, axillary placement of an Impella should be used as a bridge to recovery, transplant, or a durable LVAD. The Impella device (Figure 3) is a miniature rotary blood pump increasingly used to treat cardiogenic shock.What is the life expectancy for an LVAD? ›
Left ventricular assist device (LVAD) is usually used to keep a patient alive until a suitable heart donor is found. A patient may stay alive for 5 and a half years with LVAD. As per research, 80–85% of patients are alive a year after having an LVAD placed and 70–75% of patients are alive for 2 years with an LVAD.Is an LVAD considered life support? ›
Mechanical Circulatory Supports are considered life-sustaining therapies for patients with advanced heart failure. The LVAD is a sustaining treatment replacing left ventricle function. Stopping it would mean hastening the process of death.What is the most common LVAD device complication? ›
Bleeding is the most common complication following LVAD implantation. With earlier generation pulsatile flow pumps, rates of bleeding requiring reoperation were as high as 50% (3).Who gets an Impella? ›
“Impella is usually a device we use for patients with very weak heart functions – for example, they have multiple diseased blood vessels that need to be sorted out at the same time,” adds Dr Ong.Who puts in Impella? ›
The Impella heart pump is placed by an interventional cardiologist using standard non-surgical techniques. The device is inserted through a small incision and advanced through the arteries and into the heart.Is a balloon pump an Impella? ›
Intra-aortic balloon pump (IABP) or Impella device are the most common devices used in cardiogenic shock to maintain hemodynamics.Can you do CPR with a VAD? ›
Until recently, CPR was discouraged for VAD patients due to fear the device's pump might become dislodged during chest compressions. No longer. "There is no evidence of a VAD being dislodged by chest compressions," Johnson says, noting that the intervention can be lifesaving.
To get an LVAD, your left ventricle has to be damaged enough to need the pump. Yet your body has to be healthy enough to undergo surgery. An LVAD may be an option if you have heart failure and you: Are waiting for a heart transplant.How much does an LVAD cost? ›
Results: The mean cost of LVAD implantation was $175,420. The mean cost of readmission was lower before LVAD than after ($12,377 vs. $19,465, respectively; p < 0.001), while monthly outpatient costs were similar ($3,364 vs.Can you fly with a LVAD? ›
The only thing you will need to be mindful of is when traveling by plane, you will need to notify the security personnel that you have an LVAD and will need to carry your VAD equipment on the plane. This will obviously not go through Security check without alarming.Can you shower with an LVAD? ›
After a VAD, patients can perform most activities that patients without heart failure perform. They can bicycle, hike, and even return to work in some cases. They can shower, have sex, and travel, with minor accommodations. LVAD patients cannot swim, play contact sports, or be away from a source of electrical power.Can you go through a metal detector with an LVAD? ›
Do not go through an airport metal detector or body scanner with your LVAD. Tell the security agents you have a mechanical heart pump and ask for a hand search instead. On your flight, stay hydrated and move around as much as possible.When is a ventricular assist device needed? ›
A left ventricular assist device (LVAD) is a pump that we use for patients who have reached end-stage heart failure. We surgically implant the LVAD, a battery-operated, mechanical pump, which then helps the left ventricle (main pumping chamber of the heart) pump blood to the rest of the body.When do you use a ventricular assist device? ›
A Ventricular Assist Device, also known as a VAD, is a mechanical pump that helps your heart to pump blood throughout your body. If your heart is very weak, you need a little help recovering from surgery or are on a heart transplant waiting list, a VAD may be recommended for you.What are the advantages of ventricular assist device? ›
A VAD can be used to temporarily help your heart or as a permanent support. By relieving the heart's workload, a VAD can prolong life and improve symptoms such as fatigue and breathlessness. Patients may be able to exercise and return to work. In some patients, the VAD allows the heart to recover.What is the new device for congestive heart failure? ›
The U.S. Food and Drug Administration today approved the Barostim Neo System for the improvement of symptoms in patients with advanced heart failure who are not suited for treatment with other heart failure devices, such as cardiac resynchronization therapy.What is the success rate of LVAD surgery? ›
“Even though over 60% of our LVAD patients are INTERMACS class 1 or 2 (the sickest classes), our current era four-year survival rate is 78.9% – which is almost the same as the national average at only one year,” said Dr. Peltz.
In end stage heart failure, the body can no longer compensate for the lack of blood the heart pumps, and the heart has limited functional recovery. A person may find it difficult to breathe even when they are resting.Who is not eligible for LVAD? ›
LVADs are not appropriate for some people with advanced heart failure if they also have other conditions such as kidney failure, liver disease, lung disease, or blood clotting disorders.Can you turn off an LVAD? ›
Since part of the device is implanted within the patient, an LVAD is 'turned-off,' akin to deactivating an implantable defibrillator. However, LVADs have an external power source and associated controlling unit which are removed from a patient, analogous to removing a ventilator.How common is RV failure after LVAD? ›
One of the significant drivers of postoperative morbidity and mortality following LVAD implantation is right ventricular failure (RVF). RVF is estimated to occur in 9% to 42% of patients post-LVAD implantation, depending on the diagnostic criteria used.Can a patient be on hospice with an LVAD? ›
In the U.S., hospice may provide this care, but few patients enroll, and information about hospice experience with LVAD-implanted patients is limited.Is heart transplant better than LVAD? ›
Seven studies presented a head to head comparison between HTx and LVAD BTT for 1-year mortality. Our meta-analysis showed that there was no significant difference in 1-year mortality rates between these two groups (pooled OR: 0.91; 95% CI: 0.62–1.32) (Figure 2), without significant heterogeneity (I2 =21.2).Can an LVAD cause a stroke? ›
Both ischemic and hemorrhagic stroke are common complications of LVADs, and stroke remains the commonest cause of death between 6 and 24 months postimplantation .What are right and left ventricular assist devices? ›
An implanted left ventricular assist device (LVAD) helps pump blood from the left ventricle of your heart and on to the rest of your body. An external right ventricular assist device (RVAD) helps support the right ventricle's function.How many parts make up a ventricular assist device? ›
Ventricular Assist Device Types
All LVADs have three parts: a blood pump. a computer, called a controller, and. a power supply that remains outside of the body.
The Impella device is a catheter-based miniaturized ventricular assist device that pumps blood from left ventricle (LV) into ascending aorta and responsible for systemic circulation at an upper rate between 2.5 and 5.0 L/min.
A left ventricular assist device (LVAD) is a pump that we use for patients who have reached end-stage heart failure. We surgically implant the LVAD, a battery-operated, mechanical pump, which then helps the left ventricle (main pumping chamber of the heart) pump blood to the rest of the body.What is the longest someone has lived with an LVAD? ›
At age 84, Gayle, holds the honor of living on a left ventricular assist device (LVAD) for 10 years. Those odds don't always work that kind of wonder for many – only a few patients in the U.S. have achieved that milestone.What is the most common type of VAD? ›
The most common type, known as an LVAD, supports the left ventricle of the heart. Other devices support the right ventricle (RVADs) or both chambers (biventricular assist devices, or BiVADS).Do you have a heartbeat with an LVAD? ›
An impeller within the pump spins thousands of times a minute, resulting in continuous blood flow, which means LVAD patients don't have a pulse or measurable blood pressure.Can you go home with Impella? ›
What is Impella? Impella heart pumps have the unique ability to enable heart recovery, allowing patients to return home with their native hearts. Impella is the only non-surgical heart pump that is FDA-approved as safe and effective for high-risk patients receiving a percutaneous coronary intervention (PCI).What is the survival rate of left ventricular dysfunction? ›
Generally, 50% of patients with left ventricular dysfunction go one to live beyond 5 years after being diagnosed. 2. What are some of the treatment guidelines for left ventricular diastolic dysfunction?What is the most common cause left ventricular dysfunction? ›
Left ventricular systolic dysfunction is the most common cause of cardiogenic pulmonary edema. This dysfunction can be the result of coronary artery disease, hypertension, valvular heart disease, cardiomyopathy, toxins, endocrinologic or metabolic causes, or infections.What is the new drug for left ventricular dysfunction? ›
“Empagliflozin is a vital new therapeutic option to reduce the risk of cardiovascular death and hospitalization for adults with heart failure with reduced ejection fraction.”