Ask Dr. Z

There are many different scenarios in which we have used the impella lately and would like clarification as to when we can charge the removal on the same day as insertion.  (Also trying to clarify definition of separate distinct session.)  For instance: Impella inserted in cath lab for procedure that would be done in different department later in the day.  At the end of the procedure in the other department, the Impella is removed. Impella inserted in cath lab for procedure in cath lab, but patient goes back to his room, and a few hours later when the MD is available, it is removed.  Impella inserted in EP procedure room by cardiologist for a left heart catheterization by cath lab staff, followed by an EP procedure by EP staff.  Hours later after the ablation, the Impella is removed by the cardiologist while still in the EP lab.  The IABP is a different class of assist device but curious as to when it's appropriate to bill removal on the same day as well.  We understand if put in for a procedure and removed at the end of a procedure, the removal is not billable.  However, when put in for a procedure but left in for continued support (for a few hours) and then removed, can the removal be charged?