Hearing that an Impella® Case didn’t get Reimbursed

August 1, 2016

Q :The CFO at my hospital says that the costs associated with one of the Protected PCI™ cases that I performed were not reimbursed because the patient was discharged as an outpatient.  How can this be?  The patient only stayed one night in the hospital and didn’t meet criteria to be an inpatient.  Why wouldn’t this procedure be reimbursed because they went home sooner?  This is supposed to be a benefit of Protected PCI with the Impella 2.5™ heart pump.

A: Reduction in length of stay is one of the many benefits to Protected PCI with Impella 2.5 procedures.  Impella is listed on the Medicare “Inpatient Only Procedure” list.  All “inpatient only” procedures are excluded from the Medicare Two Midnight Stay Rule, regardless of the time spent in the hospital.  However, a formal “Admit to inpatient” status order is still required, prior to the patient being discharged from the hospital.  Without this order, the patient status remains outpatient.  There is no reimbursement for Impella as an outpatient procedure.   Unfortunately, if this happens, you are not able to update the patient status once the patient is discharged from the hospital and the situation cannot be appealed on the backend of a claim.  A simple solution for this is to write an “admit to inpatient” status order as soon as possible after inserting the Impella device.  Other physicians participating in the care of the patient should not change this inpatient status order prior to discharge.

Many hospitals are now adopting quality efforts to prevent "never events "such as decubitus ulcer's, wrong side surgery and DVT. A medical documentation "never event" for Impella is never keep a patient status as “outpatient or observation”. Always update patient status to “Admit to inpatient” prior to patient discharge.

Should you have additional questions, please email us at reimbursement@abiomed.com.  

To learn more about the Impella® platform of heart pumps, including important risk and safety information associated with the use of the devices, please visit: www.protectedpci.com/indications-use-safety-information/