TN 11 (04-14)

DI 23022.570 Ventricular Assist Device Recipient — Left, Right, or Biventricular

COMPASSIONATE ALLOWANCE INFORMATION

ALTERNATE NAMES

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

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 people who have weakened hearts or advanced heart failure.

There are three primary reasons for implanting a VAD:

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

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

  3. VADs are used as a long-term treatment for people with end stage heart failure who are not candidates for heart transplant (for example, people 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 CODING

Diagnostic testing: Imaging studies, electrocardiogram (EKG), echocardiography, and blood tests to monitor for infections.

    

ICD-9: 428.9

ONSET AND 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

People 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, electrocardiogram (EKG), and echocardiography.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets Listing

  

Medical Equals

    4.09

104.09

Documentation of 90 consecutive days or more of implanted VAD establishes listing-level medical equivalence of 4.09 or 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).

* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423022570
DI 23022.570 - Ventricular Assist Device Recipient -- Left, Right, or Biventricular - 04/11/2014
Batch run: 04/11/2014
Rev:04/11/2014