Q&A: Adding qualifiers for ICD-10-PCS tandem heart insertion

Q: Are biventricular qualifiers needed when reporting TandemHeart insertion procedures in ICD-10-PCS?

A: No. These are only inserted percutaneously. You don't have to worry about the qualifiers on a TandemHeart. There's no biventricular qualifier for this one. Therefore, it would be reported, much like an Impella device, with ICD-10-PCS code 02HA3RZ (Insertion of short-term external heart assist system into heart, percutaneous approach), according to the 2024 ICD-10-PCS Tables and Index.

TandemHearts are a form of short-term external heart assist system. A provider inserts it through the femoral vein, and it goes into the right atrium. There's a transeptal puncture so that the tip of the catheter ends up in the left atrium.

Then, the provider puts a second cannula into the femoral artery. So, oxygen-rich blood gets pulled out of the left atrium through that one cannula, then delivered back into the arterial circulation systemic through the femoral artery cannula.

This procedure aims to improve cardiac output, decrease myocardial oxygen consumption, and can provide anterograde flow at a rate of up to 4-5 L/min. It is indicated in patients suffering cardiogenic shock and high-risk percutaneous coronary intervention.

Editor’s note: This Q&A was originally published in JustCoding. Adriane Martin, DO, FACOS, CCDS, vice president of physician services at Enjoin, answered this question during the HCPro webinar, “Clarify 2023 ICD-10-PCS Coding for Cardiovascular Disease Treatments.”