Notification



Notification Issue Date:



Medical Policy Bulletin


Title:Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)

Policy #:05.00.29k

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.


The Company makes decisions on coverage based on Policy Bulletins, benefit plan documents, and the member’s medical history and condition. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable.

When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's contract.

An automatic external defibrillator (AED) is considered medically necessary and, therefore, covered when an individual has a prescription for the device from a professional provider, purchases the device from a durable medical equipment (DME) provider, and meets the following criteria.

ADULTS

WEARABLE
A wearable AED (Healthcare Common Procedure Coding System [HCPCS] code K0606) is considered medically necessary and, therefore, covered for individuals who are at high risk for sudden cardiac death (SCD) and have any of the following conditions:
  • A documented episode of ventricular fibrillation (VF) or a sustained (lasting 30 seconds or longer) ventricular tachyarrhythmia (VT). These dysrhythmias may be either spontaneous or induced during an electrophysiologic (EP) study, but they may not be due to a transient or reversible cause (e.g., hyperkalemia, systemic infections, severe hypoxia) and may not occur during the first 48 hours of an acute myocardial infarction (MI).
  • Familial or inherited conditions with a high risk for life-threatening VT such as long-QT syndrome or hypertrophic cardiomyopathy.
  • Either documented prior MI or dilated cardiomyopathy and a measured left ventricular ejection fraction (LVEF) less than or equal to 0.35.
  • A previously implanted defibrillator that now requires explantation.
  • As an alternative to an implantable cardioverter-defibrillator (ICD) in an individual who has a documented contraindication to an ICD (e.g., systemic infection, lack of vascular access).

NON-WEARABLE
A nonwearable AED (HCPCS code E0617) is considered medically necessary and, therefore, covered for individuals who are at high risk for SCD and have either of the following conditions:
  • A previously implanted defibrillator that now requires explantation.
  • When implantation surgery is contraindicated AND the individual has one of the following:
    • A documented episode of cardiac arrest due to VF and not due to a transient or reversible cause
    • A sustained (lasting 30 seconds or longer) VT, either spontaneous or induced during an EP study, that is not associated with acute MI and not due to a transient or reversible cause
    • Familial or inherited conditions with a high risk for life-threatening VT such as long-QT syndrome or hypertrophic cardiomyopathy
    • Coronary artery disease with a documented prior MI, a measured LVEF less than or equal to 0.35, and inducible, sustained VT or VF during an EP study. To meet this criteria, both of the following must apply:
        • The MI must have occurred more than four weeks prior to receiving an external defibrillator prescription.
        • The EP study must have been performed more than four weeks after the qualifying MI.
    • A documented prior MI, a measured LVEF less than or equal to 0.30, AND the individual must not have or have had any of the following:
        • Cardiogenic shock or symptomatic hypotension while in a stable baseline rhythm
        • Coronary artery bypass graft (CABG) surgery or percutaneous transluminal coronary angioplasty within the past three months
        • An enzyme-positive MI within the past month
        • Clinical symptoms or findings that would make the individual a candidate for coronary revascularization
        • Irreversible brain damage from pre-existing cerebral disease
        • A disease other than cardiac disease (e.g., cancer, uremia, liver failure) that is associated with a likelihood of survival of less than one year
    • Ischemic dilated cardiomyopathy (IDCM), a documented prior MI, New York Heart Association (NYHA) Class II or III heart failure, and a measured LVEF less than or equal to 0.35
    • Nonischemic dilated cardiomyopathy (NICDM) for longer than three months, NYHA Class II or III heart failure, and a measured LVEF less than or equal to 0.35
    • NYHA Class IV heart failure and one of the medically necessary criteria above

All other uses for AEDs (wearable or nonwearable) by adults are considered not medically necessary and, therefore, not covered because the available published peer-reviewed literature does not support their use in the treatment of illness or injury.

CHILDREN

WEARABLE
A pediatric wearable AED (i.e., Zoll Lifevest) is considered medically necessary and, therefore, covered for individuals who are at high risk for sudden cardiac death (SCD) and have all of the following indications:
  • Individuals under the age of 18 must have a chest circumference of 26 inches
  • Individuals who weigh at least 18.75 kg (approximately 43 pounds), the average size of an 8 year old

The LifeVest system should not be used in individuals who have an active implantable cardioverter defibrillator (ICD).

NON-WEARABLE
A pediatric non-wearable AED is considered medically necessary and, therefore, covered for children one to eight years of age who weigh less than 55 pounds (25 kilograms) and meet one or more of the medically necessary adult criteria listed above.

An adult non-wearable AED is considered medically necessary and, therefore, covered for children over eight years of age or who weigh more than 55 pounds (25 kilograms) when they meet one or more of the medically necessary adult criteria listed above.

ADULTS AND CHILDREN

Professional provider charges related to AED set-up, programming, evaluation, and analysis are eligible for reimbursement when the device is considered medically necessary.

Because the available published peer-reviewed literature does not support its use in the diagnosis or treatment of illness or injury, requests for the following are considered not medically necessary and, therefore, not covered:
  • Technological advancements or newly released upgrades to equipment, when the original equipment still functions properly and/or there are no significant changes in the individual's condition

Carrying cases or mounting hardware for the AED are not covered by the Company because they are not primarily medical in nature and are considered comfort or convenience items. Therefore, these items are not eligible for reimbursement consideration.

REQUIRED DOCUMENTATION

Myocardial infarctions (MIs) must be documented by elevated cardiac enzymes or Q-waves on an electrocardiogram. Left ventricular ejection fractions (LVEFs) must be measured by angiography, radionuclide scanning, or echocardiography.

The Company may conduct reviews and audits of services to our members regardless of the participation status of the provider. Medical record documentation must be maintained on file to reflect the medical necessity of the care and services provided. These medical records may include but are not limited to: records from the professional provider’s office, hospital, nursing home, home health agencies, therapies, and test reports. This policy is consistent with Medicare's documentation requirements, including the following required documentation.

PRESCRIPTION (ORDER) REQUIREMENTS
Before submitting a claim to the Company, the supplier must have on file a timely, appropriate, and complete order for each item billed that is signed and dated by the professional provider who is treating the member. Requesting a provider to sign a retrospective order at the time of an audit or after an audit for submission as an original order, reorder, or updated order will not satisfy the requirement to maintain a timely professional provider order on file.

PROOF OF DELIVERY
Medical record documentation must include a contemporaneously prepared delivery confirmation or member’s receipt of supplies and equipment. The medical record documentation must include a copy of delivery confirmation if delivered by a commercial carrier and a signed copy of delivery confirmation by member/caregiver if delivered by the DME supplier/provider. All documentation is to be prepared contemporaneous with delivery and be available to the Company upon request.

CONSUMABLE SUPPLIES
The durable medical equipment (DME) supplier must monitor the quantity of accessories and supplies an individual is actually using. Contacting the individual regarding replenishment of supplies should not be done earlier than approximately seven days prior to the delivery/shipping date. Dated documentation of this contact with the individual is required in the individual’s medical record. Delivery of the supplies should not be done earlier than approximately five days before the individual would exhaust their on-hand supply.

If required documentation is not available on file to support a claim at the time of an audit or record request, the durable medical equipment (DME) supplier may be required to reimburse the Company for overpayments.
Guidelines

Automatic external defibrillators (AEDs) should be ordered by an attending physician who will provide usage instructions. It is advisable that any individual potentially using an AED receive formal training in the use of the device and in basic life support techniques.

An AED should be used as stated in the manufacturer's labeling, and the device should be compatible with the corresponding manufacturer's defibrillation pads.

Transient or reversible causes of cardiac arrest may include conditions such as, but not limited to, drug toxicity, severe hypoxia, acidosis, hypokalemia, hypercalcemia, hyperkalemia, systemic infections, and myocarditis.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, AEDs are covered as durable medical equipment (DME) under the medical benefits of most of the Company’s products when the medical necessity criteria listed in this medical policy are met.

However, services that are identified in this policy as not medically necessary are not eligible for coverage or reimbursement by the Company.

US FOOD AND DRUG ADMINISTRATION (FDA) STATUS

WEARABLE AUTOMATIC CARDIOVERTER DEFIBRILLATORS (WEARABLE AUTOMATIC EXTERNAL DEFIBRILLATORS).
A wearable AED was approved by the FDA on December 18, 2001, for adults who are at risk for sudden cardiac arrest and who either are not candidates for, or refuse, an implantable cardioverter-defibrillator (ICD).

A wearable AED was approved by the FDA on December 17, 2015, for children who are at risk for sudden cardiac arrest.

AUTOMATIC EXTERNAL DEFIBRILLATORS (AEDs)/NONWEARABLE
There are numerous automatic external defibrillators approved by the FDA.

Description

Sudden cardiac death, or cardiac arrest, is usually caused by cardiac arrhythmia. The most common arrhythmias that result in cardiac arrest are ventricular fibrillation (VF) and ventricular tachycardia (VT). VF is an erratic, disorganized firing of impulses from the ventricles that affect the heart's pumping and contracting ability, thereby cutting off blood flow to the brain and other vital organs. VT is a rapid heartbeat initiated within the ventricles, characterized by three or more consecutive premature ventricular beats that critically reduce the heart's ability to effectively pump blood throughout the body.

The treatment for VF and VT is defibrillation, a process in which an electronic device (defibrillator) gives an electric shock to the heart. The electric shock resets the electrical state of the heart, thereby enabling the heart to beat to a rhythm controlled by its own natural pacemaker cells. Defibrillation helps re-establish normal contraction rhythms in a heart that has a dangerous arrhythmia or is in cardiac arrest. Left untreated, VF and VT can lead to cardiac arrest that is fatal within minutes. Studies have shown that individuals who survive severe cardiac arrhythmias do so because defibrillation is performed almost immediately.

Although the focus of this policy is automatic (automated) external defibrillators (AEDs), it should be noted that for most individuals at high risk for cardiac arrhythmias, an implantable cardioverter-defibrillator (ICD) is the treatment of choice. The surgically implanted ICD is designed to constantly monitor an individual's heart rate, recognize VF or VT, and deliver an electric shock to terminate these arrhythmias in order to reduce the risk of sudden death. When an ICD is not an option for an individual at risk for sudden death due to cardiac arrhythmias, an AED is necessary.

An AED is a wearable or nonwearable device that monitors cardiac rhythms. AEDs are used to treat potentially lethal dysrhythmias by delivering an electric shock to the heart through monitoring electrodes that are attached to an affected individual's chest. The AED collects information about the heart's rhythm that is immediately analyzed. If the analyzed rhythm is interpreted to be VF or VT, the AED can automatically or manually deliver a defibrillating shock to restore normal heart rhythm.

A wearable AED is a vest-like garment (worn under clothing) that automatically defibrillates an individual's heart. A nonwearable AED is a portable device that is used by someone other than the affected individual to effect defibrillation. Both types of AEDs consist of a monitor, electrodes, and a small alarm module.

The US Food and Drug Administration (FDA) has approved several AEDs that can be used by individuals outside of a health care facility. On May 2, 2001, the FDA approved the first external defibrillators to be used on children who experience cardiac arrest. The device, known as the Heartstream FR2 AED (Agilent Technologies, Inc., Santa Clara, CA), is equipped with pediatric-sized attenuated electrode pads and cables that emit a shock suitable for children. Both the American Heart Association (AHA) and the Pediatric Advanced Life Support Task Force of the International Liaison Committee on Resuscitation (ILCOR) have recommended using an AED only when it can deliver a pediatric dose and when the child is between one and eight years of age with no signs of circulation. According to the ILCOR, an AED should not be used on children under one year of age.

Other manufacturers, such as Welch Allyn, maker of the Pediatric Energy Reducer for AED 10®, provide the pediatric attenuator as a separate accessory. According to the manufacturer, the Energy Reducer for AED 10® facilitates the use of less costly non-attenuating electrodes for all individuals, eliminating the potential to confuse attenuating electrodes with non-attenuating electrodes, as well as the need to ensure sufficient stock of the two styles of electrodes.

On December 18, 2001, the FDA approved the Wearable Cardioverter Defibrillator (WCD®) 2000 LifeVest (Lifecor, Inc., Pittsburgh, PA) for individuals over 18 years of age. The WCD® is an external device, worn 24 hours a day (except when bathing or showering), that functions like an ICD. It is a noninvasive, vest-like garment (worn under clothing) that consists of a monitor, electrodes, and a small alarm module that constantly checks and analyzes heart rhythm. If an abnormal shockable heart rhythm (ie, VT or VF) is detected, a shock will be delivered. The device displays a message prior to delivering the shock, and an individual is able to prevent the shock by holding and pressing the response buttons. But if the individual loses consciousness while holding the buttons, the release of the buttons will automatically trigger the defibrillator to deliver the shock in an attempt to restore normal heart rhythm.

On December 17, 2015, the U.S. Food and Drug Administration approved a new indication for the LifeVest (ZOLL Manufacturing Corporation, Pittsburgh, PA) wearable cardioverter defibrillator. The LifeVest is approved for children who are at risk for sudden cardiac arrest, but who are not candidates for an implantable defibrillator due to certain medical conditions or lack of parental consent.

Weighing less than two pounds, the LifeVest consists of two main components: an electrode belt and garment that surround the patient’s chest, and a monitor that the patient wears around his or her waist. This device is intended only for children that weigh at least 41 pounds and have a chest size of 26 inches or more, about the size of an average 8 year old.

The pediatric approval was based on published studies and a company registery containing clinical information from 248 patients, ages 3 to 17, at risk for sudden cardiac arrest. No additional safety concerns were identified during the study. Four individuals who experienced sudden cardiac arrest received a shock that successfully restored a life-sustaining heartbeat.

Cardiopulmonary resuscitation and the use of a portable AED are emergency techniques that assist an individual in the management of cardiac arrest until emergency personnel arrive. It is advisable that any individual potentially using these techniques have formal training in the use of the device and in basic life support.
References


American Heart Association (AHA). AED programs Q&A. [AHA Web site]. 02/11/2013. Available at: http://www.heart.org/HEARTORG/CPRAndECC/WorkplaceTraining/AEDResources/AED-Programs-Q-A_UCM_323111_Article.jsp. Accessed April 12, 2018.

Business Wire (BNET). Medtronic unveils the LIFEPAK® 1000 Defibrillator; adding to its advanced patient-focused solutions for professional emergency responders. [BNET Web site]. 03/23/06. Available at: http://www.businesswire.com/news/home/20060323005472/en/Medtronic-Unveils-LIFEPAK-1000-Defibrillator-Adding-Advanced. Accessed April 12, 2018.

Noridian Healthcare Solutions, LLC. Policy Article. (A52458): Automatic external defibrillators. 01/01/2017. Available at: https://med.noridianmedicare.com/documents/2230703/7218263/Automatic+External+Defibrillators/10f0b92d-0c55-4b5d-aa15-b952b37c70ce Accessed April 12, 2018.

Noridian Healthcare Solutions, LLC. Local Coverage Determination (LCD).L33690: Automatic external defibrillators. 01/01/2017. Available at:
https://med.noridianmedicare.com/documents/2230703/7218263/Automatic+External+Defibrillators/10f0b92d-0c55-4b5d-aa15-b952b37c70ce Accessed April 12, 2018.

Philips. HeartStart FR2+ Defibrillator. [Philips Web site]. Available at: http://www.heartstarthome.com/content/product_overview/faq_detail.asp. Accessed April 12, 2018.

US Food and Drug Administration (FDA). FDA Approves Wearable Defibrillator for Children at Risk for Sudden Cardiac Death. Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm466852.htm. Accessed April 12, 2018.

US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Devices@FDA. LIFEPAK 500 Biphasic. [FDA Web site]. 01/31/14. Available at: http://www.accessdata.fda.gov/scripts/cdrh/devicesatfda/index.cfm?db=PMN&id=K983393. Accessed April 12, 2018.

US Food and Drug Administration (FDA). Center for Devices and Radiological Health. HeartSine Samaritan® PAD. 510(k) summary. [FDA Web site]. 05/25/04. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf4/k041067.pdf. Accessed April 12, 2018.

US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Heartstream FR2 AED. 510(k) summary. [FDA Web site]. 10/03, 2005. Available at: https://www.accessdata.fda.gov/cdrh_docs/pdf5/K051632.pdf. Accessed April 12, 2018.

US Food and Drug Administration (FDA). Center for Devices and Radiological Health. LIFECOR Wearable Cardioverter Defibrillator (WCD®) 2000 System. [FDA Web site]. 04/19/02. Available at:
https://www.fda.gov/iceci/enforcementactions/warningletters/2014/ucm417438.htm. Accessed April 12, 2018.

US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Medtronic Physio-Control Infant/Child Reduced Energy Electrodes. 510(k) summary. [FDA Web site]. 12/13/02. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf2/K022732.pdf. Accessed April 12, 2018.

US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Wearable Cardioverter Defibrillator (WCD®) 2000 System. Summary of safety and effectiveness data. [FDA Web site]. 12/18/01. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf/P010030b.pdf. Accessed April 12, 2018.

US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Pediatric energy reducer for AED 1®; pediatric energy reducer for AED 2O®. Premarket approval letter. [FDA Web site]. 09/14/04. Available at:http://www.accessdata.fda.gov/cdrh_docs/pdf4/K040479.pdf. Accessed April 12, 2018.

US Food and Drug Administration (FDA). Device approvals and clearances. Heartstream FR2 AED with Attenuated Defibrillation Pads. [FDA Web site]. 05/02/01. Available at: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm088983.htm. Accessed April 12, 2018.

US Food and Drug Administration (FDA). FDA Patient Safety News, Show #34. Advising patients on OTC defibrillators. [FDA Web site]. December 2004. Available at: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/psn/printer.cfm?id=282. Accessed April 12, 2018.

US Food and Drug Administration (FDA). FDA products and medical procedures. What Is an External Defibrillator? 11/10/10. [FDA Web site]. Available at: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/CardiovascularDevices/ExternalDefibrillators/ucm232088.htm?utm_campaign=Google2&utm_source=fdaSearch&utm_medium=website&utm_term=Wearable Defibrillators&utm_content=3. Accessed April 12, 2018.

Wase A, Wilson A. Wearable defibrillators: A new tool in the management of ventricular tachycardia/ventricular fibrillation. [EP Lab Digest Web site]. 12/12/05. Available at: http://www.eplabdigest.com/articles/Wearable-Defibrillators-A-New-Tool-Management-Ventricular-TachycardiaVentricular-Fibrillati. Accessed April 12, 2018.





Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

93292, 93745


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

SEE ATTACHMENT A FOR ICD-10 CODES THAT ARE USED TO REPRESENT INDICATIONS FOR THE WEARABLE AUTOMATIC EXTERNAL DEFIBRILLATOR (AED


SEE ATTACHMENT B FOR ICD-10 CODES THAT ARE USED TO REPRESENT INDICATIONS FOR THE NONWEARABLE AUTOMATIC EXTERNAL DEFIBRILLATOR (AED)



HCPCS Level II Code Number(s)

THE FOLLOWING CODE IS USED TO REPRESENT NONWEARABLE AUTOMATIC EXTERNAL DEFIBRILLATOR (AED):


E0617 External defibrillator with integrated electrocardiogram analysis

THE FOLLOWING CODE IS USED TO REPRESENT WEARABLE AED:

K0606 Automatic external defibrillator with integrated electrocardiogram analysis, garment type

THE FOLLOWING CODES ARE USED TO REPRESENT REPLACEMENT SUPPLIES AND ACCESSORIES FOR AN AED:

K0607 Replacement battery for automated external defibrillator, garment type only, each

K0608 Replacement garment for automatic external defibrillator, each

K0609 Replacement electrodes for use with automated external defibrillator, garment type only, each



Revenue Code Number(s)

N/A

Coding and Billing Requirements


Cross References

Attachment A: Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)
Description: ICD-10 Codes used to represent the Wearable Automatic External Defibrillator (AED):

Attachment B: Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)
Description: ICD-10 codes used to represent the Nonwearable Automatic External Defibrillator (AED):




Policy History

Revisions from 05.00.29k
04/25/2018The policy has been reviewed and reissued to communicate the Company’s continuing position on Automatic External Cardioverter Defibrillators (Wearable and Nonwearable).
12/27/2017This version of the policy will become effective 12/27/2017.

The following codes were added for K0606:
I21.4, I22.0, I22.1, I22.2, I22.8, I22.9, I25.2, I42.0, I42.1, I42.2, I42.3, I42.4, I42.5, I42.6, I42.7, I42.8, I42.9, I43


The following ICD-10 codes were removed for E0617:

I42.0 Dilated cardiomyopathy
I42.3 Endomyocardial (eosinophilic) disease
I42.4 Endocardial fibroelastosis
I42.5 Other restrictive cardiomyopathy
I42.6 Alcoholic cardiomyopathy
I42.7 Cardiomyopathy due to drug and external agent
I42.8 Other cardiomyopathies
I42.9 Cardiomyopathy, unspecified
I43 Cardiomyopathy in diseases classified elsewhere

The following ICD-10 codes were removed for both E0617 and K0606:

T82.827A Fibrosis due to cardiac prosthetic devices, implants and grafts, initial encounter

T82.827D Fibrosis due to cardiac prosthetic devices, implants and grafts, subsequent encounter

T82.827S Fibrosis due to cardiac prosthetic devices, implants and grafts, sequela

T82.837A Hemorrhage due to cardiac prosthetic devices, implants and grafts, initial encounter

T82.837D Hemorrhage due to cardiac prosthetic devices, implants and grafts, subsequent encounter

T82.837S Hemorrhage due to cardiac prosthetic devices, implants and grafts, sequela

T82.847A Pain due to cardiac prosthetic devices, implants and grafts, initial encounter

T82.847D Pain due to cardiac prosthetic devices, implants and grafts, subsequent encounter

T82.847S Pain due to cardiac prosthetic devices, implants and grafts, sequela

T82.867A Thrombosis due to cardiac prosthetic devices, implants and grafts, initial encounter

T82.867D Thrombosis due to cardiac prosthetic devices, implants and grafts, subsequent encounter

T82.867S Thrombosis due to cardiac prosthetic devices, implants and grafts, sequela

T82.897A Other specified complication of cardiac prosthetic devices, implants and grafts, initial encounter

T82.897D Other specified complication of cardiac prosthetic devices, implants and grafts, subsequent encounter

T82.897S Other specified complication of cardiac prosthetic devices, implants and grafts, sequela


Revisions from 05.00.29j
10/01/2017This policy has been identified for the ICD-10 CM code update, effective 10/01/2017.

The following ICD-10 CM codes have been added to this policy:
  • I21.9 Acute myocardial infarction, unspecified
  • I21.A1 Myocardial infarction type 2
  • I21.A9 Other myocardial infarction type
Version Effective Date: 12/27/2017
Version Issued Date: 12/27/2017
Version Reissued Date: 04/25/2018

Connect with Us        


© 2017 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.