(Medicare Claims Processing Manual)

ICD-10 Procedure Code  Definition  Discharges Effective  02RK0JZ  Replacement of Right Ventricle with Synthetic Substitute, Open Approach  On or After ICD-10 Implementation  02RL0JZ  Replacement of Left Ventricle with Synthetic Substitute, Open Approach  02WA0JZ  Revision of Synthetic Substitute in Heart, Open Approach   NOTE: Total artificial heart is reported with a cluster of 2 codes for open replacement with synthetic substitute of the right and left ventricles- 02RK0JZ + 02RL0JZ   320.3  Ventricular Assist Devices (VADs)  (Rev.10837; Issued: 06-11- 21; Effective: 12 -01-20; Implementation: 07-27-21)  Medicare may cover a Ventricular Assist Device (VAD). A VAD is surgically attached to one or both intact ventricles and is used to assist or augment the ability of a damaged or weakened native heart to pump blood. Improvement in the performance of the nati ve heart may allow the device to be removed. Refer to the Internet Only Manual Publication 100-03, National Coverage Determination (NCD) Manual, section 20.9.1, for coverage criteria. 320.3.1  Post-cardiotomy  (Rev.10837; Issued: 06-11- 21; Effective: 12 -01-20; Implementation: 07-27-21)  Post-cardiotomy is the period following open-heart surgery. VADs used for support of blood circulation post-cardiotomy are covered only if they have received approval from the Food and Drug Administration (FDA) for that purpose, and the VADs are used according to the FDA -approved labeling instructions.  320.3.2  VADs  for Short -term or Long -term Mechanical Circulatory Support  (Rev.10837; Issued: 06-11- 21; Effective: 12 -01-20; Implementation: 07-27-21)  Effective for claims with dates of service on or after December 1, 2020, Left ventricular assist devices (LVADs) are covered if they are FDA -approved for short-term (e.g., bridge- to-recovery and bridge- to-transplant) or long-term (e.g., destination therapy) mechanical circulatory support for heart failure patients who meet spec ific clinical criteria outlined in NCD 20.9.1.   320.3.3  Other (Rev. 12396; Issued: 12-07- 23; Effective: 01 -09-24; Implementation: 01-09-24)  All other indications for the use of VADs not otherwise listed remain non-covered, except in the context of Category B investigational device exemption clinical trials (42 CFR 405) or as a routine cost in clinical trials defined under section 310.1 of the NCD Manual.  Claims Coding  Appropriate ICD -10 diagnosis and procedure codes are included below:  ICD-10 Diagnosis Code  Definition  I09.81  Rheumatic heart failure  I11.0  Hypertensive heart disease with heart failure   I13.0  Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease,  or unspecified chronic kidney disease   I13.2  Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end  stage renal disease  I20.0  Unstable angina   I21.01  ST elevation (STEMI) myocardial infarction involving left main coronary artery   ST elevation (STEMI) myocardial infarction involving left  I21.02  anterior descending coronary artery   I21.09  ST elevation (STEMI) myocardial infarction involving  other coronary artery of anterior wall   I21.11  ST elevation (STEMI) myocardial infarction involving  right coronary artery   I21.19  ST elevation (STEMI) myocardial infarction involving  other coronary artery of inferior wall   I21.21  ST elevation (STEMI) myocardial infarction involving left  circumflex coronary artery   I21.29  ST elevation (STEMI) myocardial infarction involving  other sites   I21.3  ST elevation (STEMI) myocardial infarction of  unspecified site  I21.4  Non-ST elevation (NSTEMI) myocardial infarction   I22.0  Subsequent ST elevation (STEMI) myocardial infarction  of anterior wall   I22.1  Subsequent ST elevation (STEMI) myocardial infarction  of inferior wall   I22.2  Subsequent non -ST elevation (NSTEMI) myocardial  infarction   I22.8  Subsequent ST elevation (STEMI) myocardial infarction  of other sites   I22.9  Subsequent ST elevation (STEMI) myocardial infarction of unspecified site   I24.0  Acute coronary thrombosis not resulting in myocardial  infarction  I24.1  Dressler's syndrome  I24.81  Acute coronary microvascular dysfunction Effective 10/1/23  I24.89  Other forms of acute ischemic heart disease Effective 10/1/23  I24.9  Acute ischemic heart disease, unspecified   I25.10  Atherosclerotic heart disease of native coronary artery  without angina pectoris   Atherosclerotic heart disease of native coronary artery  I25.110  with unstable angina pectoris   I25.111  Atherosclerotic heart disease of native coronary artery with  angina pectoris with documented spasm  I25.112  Atherosclerotic heart disease of native coronary artery with refractory angina pectoris   I25.118  Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris   I25.119  Atherosclerotic heart disease of native coronary artery  with unspecified angina pectoris  I25.5  Ischemic cardiomyopathy  I25.6  Silent myocardial ischemia   I25.700  Atherosclerosis of coronary artery bypass graft(s),  unspecified, with unstable angina pectoris   I25.701  Atherosclerosis of coronary artery bypass graft(s),  unspecified, with angina pectoris with documented spasm   I25.708  Atherosclerosis of coronary artery bypass graft(s),  unspecified, with other forms of angina pectoris   I25.709  Atherosclerosis of coronary artery bypass graft(s),  unspecified, with unspecified angina pectoris   I25.710  Atherosclerosis of autologous vein coronary artery bypass  graft(s) with unstable angina pectoris   I25.711  Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm   I25.718  Atherosclerosis of autologous vein coronary artery bypass  graft(s) with other forms of angina pectoris   I25.719  Atherosclerosis of autologous vein coronary artery bypass  graft(s) with unspecified angina pectoris   I25.720  Atherosclerosis of autologous artery coronary artery  bypass graft(s) with unstable angina pectoris   I25.721  Atherosclerosis of autologous artery coronary artery  bypass graft(s) with angina pectoris with documented spasm   I25.728  Atherosclerosis of autologous artery coronary artery  bypass graft(s) with other forms of angina pectoris   I25.729  Atherosclerosis of autologous artery coronary artery  bypass graft(s) with unspecified angina pectoris   I25.730  Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris   I25.731  Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with  documented spasm   I25.738  Atherosclerosis of nonautologous biological coronary  artery bypass graft(s) with other forms of angina pectoris   I25.739  Atherosclerosis of nonautologous biological coronary  artery bypass graft(s) with unspecified angina pectoris   I25.750  Atherosclerosis of native coronary artery of transplanted  heart with unstable angina   I25.751  Atherosclerosis of native coronary artery of transplanted  heart with angina pectoris with documented spasm   I25.758  Atherosclerosis of native coronary artery of transplanted  heart with other forms of angina pectoris   I25.759  Atherosclerosis of native coronary artery of transplanted  heart with unspecified angina pectoris   I25.760  Atherosclerosis of bypass graft of coronary artery of  transplanted heart with unstable angina   I25.761  Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm   I25.768  Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris   I25.769  Atherosclerosis of bypass graft of coronary artery of  transplanted heart with unspecified angina pectoris   I25.790  Atherosclerosis of other coronary artery bypass graft(s)  with unstable angina pectoris   I25.791  Atherosclerosis of other coronary artery bypass graft(s)  with angina pectoris with documented spasm   Atherosclerosis of other coronary artery bypass graft(s)  I25.798  with other forms of angina pectoris   I25.799  Atherosclerosis of other coronary artery bypass graft(s)  with unspecified angina pectoris   I25.810  Atherosclerosis of coronary artery bypass graft(s) without  angina pectoris   I25.811  Atherosclerosis of native coronary artery of transplanted  heart without angina pectoris   I25.812  Atherosclerosis of bypass graft of coronary artery of  transplanted heart without angina pectoris  I25.89  Other forms of chronic ischemic heart disease  I25.9  Chronic ischemic heart disease, unspecified  I34.0  Nonrheumatic mitral (valve) insufficiency  I34.1  Nonrheumatic mitral (valve) prolapse  I34.2  Nonrheumatic mitral (valve) stenosis  I34.8  Other nonrheumatic mitral valve disorders  I34.9  Nonrheumatic mitral valve disorder, unspecified  I35.0  Nonrheumatic aortic (valve) stenosis  I35.1  Nonrheumatic aortic (valve) insufficiency  I35.2  Nonrheumatic aortic (valve) stenosis with insufficiency  I35.8  Other nonrheumatic aortic valve disorders  I35.9  Nonrheumatic aortic valve disorder, unspecified  I36.0  Nonrheumatic tricuspid (valve) stenosis  I36.1  Nonrheumatic tricuspid (valve) insufficiency  I36.2  Nonrheumatic tricuspid (valve) stenosis with insufficiency  I36.8  Other nonrheumatic tricuspid valve disorders  I36.9  Nonrheumatic tricuspid valve disorder, unspecified  I37.0  Nonrheumatic pulmonary valve stenosis  I37.1  Nonrheumatic pulmonary valve insufficiency   I37.2  Nonrheumatic pulmonary valve stenosis with  insufficiency  I37.8  Other nonrheumatic pulmonary valve disorders  I37.9  Nonrheumatic pulmonary valve disorder, unspecified  I38 Endocarditis, valve unspecified