AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2018 Issue 3; Ask the Editor
Decommissioning of Left Ventricular Assist Device with Exploration of Mediastinum
A patient with non-ischemic cardiomyopathy, and end-stage systolic heart failure, is status post implantation of a left ventricular assist device (LVAD). The patient’s heart recovered over time and she is now scheduled for elective decommissioning of the LVAD, by ligating the outflow-graft and cutting the driveline. During surgery, an incision was made down to the outflow graft of the pump, in the mediastinum underneath the sternum and the mediastinal area was explored. The outflow-graft was tied, pump support was reduced to no forward flow, and the outflow graft was ligated and shut down. Next, the driveline exit site was excised and the driveline was tunneled subcutaneously via the trunk and cut from the exit site. The cable and the exit site were closed. What is the correct code assignment for decommissioning of the LVAD by ligating the outflow-graft and cutting the driveline? ...
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Article Overview
This premium article explains a surgical coding scenario involving decommissioning of a left ventricular assist device after cardiac recovery, with attention to the operative work described in the mediastinum and driveline removal steps. It is intended for coders and revenue cycle staff working with cardiovascular surgery records and procedural coding decisions. The article focuses on how the operative details are characterized for code assignment and why the case requires careful review of the procedure narrative.
Why This Topic Matters
LVAD decommissioning cases can be coded differently depending on the operative approach and what was done to the device components and surrounding anatomy. Accurate interpretation supports consistent procedural reporting in complex cardiovascular surgery claims.
What You Will Learn
- How this LVAD decommissioning scenario is described in operative terms
- Which parts of the surgical record are relevant to procedural code assignment
- How mediastinal exploration and device component management factor into coding review
- Why postoperative cardiovascular device cases require careful documentation review
Who Should Read This
- Medical coders
- Coding auditors
- Revenue cycle staff
- Cardiovascular surgery billing staff
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