ALTERNATE NAMES

BiVAD Recipient; Biventricular Assist Device Recipient; Heart Assist System Implantation Recipient; Heart Pump Recipient; Implantable VAD Recipient; Implantable Ventricular Assist Device Recipient; Left Ventricular Assist Device Recipient; Left Ventricular Assist System Recipient; Long Term VAD Recipient; Long Term Ventricular Assist Device Recipient; LVAD Recipient; LVAS Recipient; Right Ventricular Assist Device Recipient; RVAD Recipient; VAD

DESCRIPTION

A ventricular assist device (VAD) is a mechanical pump surgically implanted to assist the heart in pumping blood. The two basic types of VAD are the left ventricular assist device (LVAD) and the right ventricular assist device (RVAD). If both the LVAD and RVAD are used at the same time, then they are called a biventricular assist device (BiVAD). VADs are implanted in individuals who have weakened hearts or advanced heart failure.

There are three primary reasons for implanting a VAD:

1. 1. 

   VADs are used during or after surgery, until a weakened heart recovers (“bridge to recovery”).

2. 2. 

   VADs are used for individuals waiting for a heart transplant until a donor heart can be obtained (“bridge to transplant”).

3. 3. 

   VADs are used as a long-term treatment for individuals with end stage heart failure who are not candidates for heart transplant (for example, individuals with clotting disorders, irreversible kidney failure, severe liver disease, or infections that cannot be treated with antibiotics). This is also known as “destination therapy.”

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING

Diagnostic testing: The diagnostic indicators that are evaluated prior to a VAD placement may include:

• •

  Imaging studies;

• •

  Electrocardiogram (EKG);

• •

  Echocardiography; and

• •

  Blood tests to monitor for infections.

Physical findings:

• •

  Coronary artery disease and heart attack;

• •

  High blood pressure;

• •

  Faulty heart valves;

• •

  Damage to the heart muscle (cardiomyopathy);

• •

  Myocarditis (inflammation of the heart muscles);

• •

  Congenital heart defects; and

• •

  Abnormal heart rhythms (heart arrhythmias).    

ICD-9: 428.9

ICD-10: Z95.811

PROGRESSION

Prior to implantation of the VAD, individuals are admitted into the hospital to prepare them for surgery. During this time, patients receive instruction on how the device works, safety precautions, how to respond to alarms, what to do in the event of a loss of electrical power, personal care before and after the implant, and how to prepare for changes in activities of daily living. Following implantation, there is a risk of infection, internal bleeding, heart failure, and mechanical breakdown of the VAD. Response to implantation of a VAD depends on the severity of the heart condition. Individuals with complications following surgery may require cardiac rehabilitation. Cardiac rehabilitation involves prescribed exercise training, education on heart healthy living, and counseling to reduce stress. VAD recipients are medically monitored on a regular basis.

TREATMENT

Individuals who require mechanical circulatory support of a VAD may require prolonged ventilation due to postoperative respiratory failure. Mobility is often limited due to multiple medical problems, life-support or monitoring equipment and weakness. These individuals may require physical therapy intervention, respiratory therapy, and cardiac rehabilitation on a case-by-case basis.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

• •

  Clinical description of findings;

• •

  Hospital admission and discharge summary;

• •

  Operative report;

• •

  Cardiology consultation;

• •

  Imaging studies;

• •

  EKG; and

• •

  Echocardiography.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

Equals

4.09

Documentation of 90 consecutive days or more of implanted VAD establishes listing-level medical equivalence of listing 4.09. Choose one-year diary from the date of surgical implantation of VAD. After one year following the date of surgical implantation, evaluate residual impairment(s).

104.09

Documentation of 90 consecutive days or more of implanted VAD establishes listing-level medical equivalence of listing 104.09. Choose one-year diary from the date of surgical implantation of VAD. After one year following the date of surgical implantation, evaluate residual impairment(s).