© Copyright 2025 American Medical Association. All rights reserved.
An extracorporeal ventricular assist device (VAD) is a mechanical device designed to support the heart's function by assisting in the pumping of blood. This procedure involves the insertion of a VAD into one or both ventricles of the heart, which is particularly beneficial for patients experiencing severe heart failure or those awaiting a heart transplant. The VAD consists of several components, including a mechanical pump, a control system, and an energy supply, all of which work together to facilitate blood circulation. Unlike implantable devices, an extracorporeal VAD operates externally, with pumps connected to the heart via cannulas. The procedure typically requires a median sternotomy to gain access to the heart, and cardiopulmonary bypass is initiated to maintain blood flow during the surgery. The insertion of a left VAD involves specific steps, such as placing a partial occluding clamp on the aorta, suturing an outflow graft, and carefully inserting the inflow cannula into the left ventricle. If a right VAD is necessary, similar techniques are employed, with adjustments made for the pulmonary artery and right ventricle. This procedure is critical for patients who need temporary support for their heart function, allowing for recovery or bridging to a more permanent solution, such as a heart transplant.
© Copyright 2025 Coding Ahead. All rights reserved.
The insertion of a ventricular assist device (VAD) is indicated for patients with specific conditions that necessitate mechanical support for the heart. These indications include:
The procedure for the insertion of an extracorporeal ventricular assist device (VAD) involves several critical steps to ensure proper placement and function of the device. The process begins with a median sternotomy, which is performed to expose the heart. Once access is achieved, cardiopulmonary bypass is initiated to maintain blood circulation while the heart is temporarily stopped. If a left VAD is being inserted, a partial occluding clamp is placed on the aorta to control blood flow. The aorta is then incised, and an outflow graft is sutured to it to facilitate blood ejection from the left ventricle. The left ventricular apex is elevated, and double purse-string sutures are placed around the planned insertion site in the left ventricle, reinforced with bovine pericardial pledgets for stability. A cruciate incision is made at the apex within the surrounding suture line, allowing for the insertion of the inflow cannula. The purse-string sutures are tightened around the cannula to secure it in place. Once the device is filled with blood, the inflow cannula and outflow graft are connected to the pump, which is then linked to a battery pack for power. The patient is gradually weaned off cardiopulmonary bypass, and the flow of the VAD is checked and adjusted as necessary. Hemostasis at the cannula and graft site is confirmed, and pacing wires are placed to monitor heart rhythm. A chest tube is inserted to drain any excess fluid, and the chest incisions are subsequently closed. If a right VAD is required, the procedure is performed similarly, with an inflow graft placed in the pulmonary artery and an outflow cannula positioned in the right ventricle.
After the insertion of the ventricular assist device (VAD), patients typically require close monitoring in a critical care setting. Post-procedure care includes assessing the function of the VAD, ensuring proper blood flow, and checking for any signs of complications such as bleeding or infection at the cannula and graft sites. Patients may need to remain on anticoagulation therapy to prevent thrombus formation within the device. Recovery may involve a gradual weaning process from mechanical support, with ongoing evaluations of cardiac function and overall health. The healthcare team will also provide education on managing the VAD, including recognizing potential issues and understanding the importance of follow-up care. The length of recovery and hospital stay can vary based on the patient's condition and response to the procedure.
| Short Descr | IMPLANT VENTRICULAR DEVICE | Medium Descr | INSJ VENTRIC ASSIST DEV XTRCORP SINGLE VENTRICLE | Long Descr | Insertion of ventricular assist device; extracorporeal, single ventricle | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 1 | CCS Clinical Classification | 49 - Other OR heart procedures |
This is a primary code that can be used with these additional add-on codes.
| 33257 | Addon Code MPFS Status: Active Code APC C Illustration for Code Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), limited (eg, modified maze procedure) (List separately in addition to code for primary procedure) | 33259 | Addon Code MPFS Status: Active Code APC C Illustration for Code Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), extensive (eg, maze procedure), with cardiopulmonary bypass (List separately in addition to code for primary procedure) | 34714 | Addon Code MPFS Status: Active Code APC N ASC N1 Open femoral artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by groin incision, unilateral (List separately in addition to code for primary procedure) | 34716 | Addon Code MPFS Status: Active Code APC N ASC N1 Open axillary/subclavian artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by infraclavicular or supraclavicular incision, unilateral (List separately in addition to code for primary procedure) | 34833 | Addon Code Resequenced Code MPFS Status: Active Code APC C CPT Assistant Article Open iliac artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by abdominal or retroperitoneal incision, unilateral (List separately in addition to code for primary procedure) |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 81 | Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number. | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2002-01-01 | Changed | Code description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
Get instant expert-level medical coding assistance.