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A ventricular assist device (VAD) is a sophisticated mechanical pump designed to provide circulatory support for patients suffering from heart failure. These devices are primarily utilized to assist the heart's left ventricle, which is responsible for pumping oxygenated blood to the body. In certain clinical scenarios, the positioning of the VAD may require adjustment, particularly if the device has advanced too far into the heart, resulting in both the inflow and outflow areas being fully situated within the left ventricle. In such instances, a physician may need to reposition the device by carefully pulling it back to ensure optimal function. For right heart ventricular assist devices, the repositioning process involves adjusting the cannulas under imaging guidance. This is crucial to confirm that the inflow cannula is correctly positioned with its tip located in the right atrium, while the outflow cannula must be accurately placed within the pulmonary artery. The repositioning procedure is typically conducted under fluoroscopic guidance, which allows for real-time imaging to ensure precise placement. Additionally, some VADs are equipped with a repositioning sheath that facilitates bedside adjustments, enhancing the flexibility and efficiency of the repositioning process.
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The repositioning of a percutaneous right or left heart ventricular assist device is indicated in specific clinical situations where the device's placement may compromise its function or the patient's health. The following conditions warrant this procedure:
The procedure for repositioning a percutaneous right or left heart ventricular assist device involves several critical steps to ensure the device is correctly placed for optimal function. The following procedural steps are typically followed:
After the repositioning of the ventricular assist device, the patient requires careful monitoring to assess the effectiveness of the procedure and to identify any potential complications. This includes observing vital signs, hemodynamic parameters, and overall patient stability. The healthcare team will ensure that the VAD is functioning properly and that the cannulas remain in the correct position. Additionally, any signs of infection, bleeding, or other adverse effects must be promptly addressed. The patient may also receive instructions regarding activity restrictions and follow-up appointments to evaluate the ongoing performance of the VAD and the patient's recovery.
| Short Descr | REPOSG PERQ R/L HRT VAD | Medium Descr | REPOSITIONING PERQ R/L VAD W/IMG GDN SEP INSJ | Long Descr | Repositioning of percutaneous right or left heart ventricular assist device with imaging guidance at separate and distinct session from insertion | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | 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 | 50 - Extracorporeal circulation auxiliary to open heart procedures |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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). | AG | Primary physician | 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 | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | 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 |
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| 2022-01-01 | Changed | AMA guideline removed. |
| 2021-01-01 | Changed | Code changed. |
| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. Guideline added. |
| 2013-01-01 | Added | Added |
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