The Central Office on ICD-10-CM/PCS has received numerous requests regarding the reporting of an intra-aortic balloon pump (IABP). The following information regarding an IABP, along with some coding examples, is being provided to help clarify the coding issues.
An intra-aortic balloon pump (IABP) provides circulatory support by helping the heart pump blood. Specifically, it is a polyethylene balloon mounted on a catheter that is generally inserted into the descending aorta through the femoral artery. The other end of the catheter attaches to a computer console containing a pump that inflates the balloon. The balloon at the end of the catheter inflates and deflates with the rhythm of the heart, helping the heart to pump blood into the body. At the start of diastole, the balloon inflates augmenting coronary perfusion. At the beginning of systole, the balloon deflates and blood is ejected from the left ventricle increasing cardiac output. These actions decrease the workload on the heart and allow the heart to pump more blood.
The IABP is driven by a balloon pump console and can be programmed to produce rates as high as 140 beats per minute. IABP therapy was first used for surgical patients but is now being used with interventional cardiology procedures and medical therapy. Some indications for IABP therapy include failure to wean from cardiopulmonary bypass, cardiogenic shock, heart failure, acute heart attack, and support during some cardiology procedures such as angioplasty and stent placement. An IABP may be used pre-, intra-, or postoperatively to support the patient for a few hours up to several days.As specifically indicated on page 10 of the First Quarter 2017 issue of Coding Clinic, the advice for coding external heart assist devices does not apply to the placement or removal of intra-aortic balloon pumps. Therefore, it is not appropriate to report an IABP with the device value “external heart assist device.” Additionally, from a coding perspective, the IABP is not classified as a device, nor coded as a device in ICD-10-PCS. Since an IABP is not considered a device under ICD-10-PCS, it would also not be appropriate to report the root operations “insertion” and/or “removal” for the placement or removal of the intra-aortic balloon pump. The use of an IABP is appropriately coded using the root operation “Assistance.”
The patient was admitted as an inpatient for percutaneous coronary intervention (PCI). An intra-aortic balloon pump (IABP) was placed for support, and it was removed at the end of the procedure. Is it appropriate to report the intraoperative use of the IABP?
Typically, auxiliary procedures done solely to support the performance of a surgical procedure are not coded separately. However, cardiopulmonary bypass and IABP are exceptions. When a surgical procedure is performed using IABP, code separately with the root operation “Assistance.” Assign the following ICD-10-PCS code:
5A02210 Assistance with cardiac output using balloon pump, continuous, for the intraoperative use of IABP support
This advice supersedes information previously published in Coding Clinic Third Quarter 2013, pages 18-19.
When an intra-aortic balloon pump (IABP) is left in place at the completion of the procedure but is removed a few hours later, would the assistance code and removal code both be assigned?
The IABP is not classified as a device for ICD-10-PCS under any circumstances, and therefore, it is not appropriate to assign the root operation “removal.” Code the IABP as follows:
5A02210 Assistance with cardiac output using balloon pump, continuous
A patient was transferred to our facility with an intra-aortic balloon pump (IABP) already in place from another acute care facility. IABP cardiac output assistance continued for several days. Subsequently, the balloon was deflated and the IABP was removed from the aorta at bedside. Is it appropriate to report the continued IABP assistance and removal?
Code the continued IABP assistance as follows:
5A02210 Assistance with cardiac output using balloon pump, continuousIt would not be appropriate to report the root operation “removal” since an IABP is not considered a device.