CPT code help

I am having trouble finding a CPT code for the femoral exposure for the Impella device inserted during a heart catherization. Any help with this code would be appreciated.

CPT CODE help additional information

Forgot to add, that this was a co-surgeon procedure. Vascular did the opening, Cardiology did the insertion of the device and the catherization. I looked at 33975 but was not sure if this could be used since the code description did not mention femoral exposure. Again thanks for any assistance on this.

Device

Need to read procedure note. Why was circulatory assist needed? Percutaneous--see codes 92970 or with some payers an unlisted code. All depends. There is another code 33975 but need all information before code assignment.

OP note attached

Preoperative diagnosis: Coronary artery disease

Postoperative diagnosis: Coronary artery disease

Operation: Left femoral artey exposure for the Impella device during a heart catheterization.

Anesthesia: Local sedation

Estimated blood loss: 100 milliliters

No complications occurred, no drains were placed.

Summary of case: The patient is an 84 year old mnan with coronary artery disease in the main vein graft to his heart. Impella device was needed and femoral exposure for the Impella device in the 16 French sheath was desired. After the risks and benefits of femoral exposure were discusses with the patient, he wished to procede.

DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was brought to the cath lab table and placed on the table in a supine position. The right and left groins were prepped and draped in the standard sterile fashion. 1% Lidocaine was infiltrated in the area over the inguinal ligament. The 15 blade was used to make a 4 cm incision. This was carried down through the subcutaneous tissues to expose the femoral artery at the inguinal ligament. This was dissected free along its course and control was gained. Needle access was gained into the artery with an introducer needle and a wire was placed proximally. The 12 French dilator was placed under direct vision and the the 16 French sheath was advanced under direct vision without difficulty. Dr. Cardiology then performed the intervention and when he had completed, clamps were placed proximally and distally in the arteries, the sheath was removed and 5-0 Prolene suture was used in an interrupted mattress suture fashion to close the arteriotomy. Flow was restored and Doppler evaluation confirmed good flow present in the distal artery. Hemostasis was achieved. The wound was closed with multiple layers of 2-0 Vicryl deeply and then running 4-0 Monocryl in the skin in subcuticular fashion. Sterile occlusive dressings were placed and the patient was taken to the recovery room in a stable condition following the case.

percutaneous

http://www.abiomed.com/images/documents/ImpellaPerc510K_021908_2.pdf
Co-surgery is modifier -62 but co-surgeons are not allowed for codes 33975 or 92970.
In April 2009 the FDA cleared the Impella 5.0, offering a flow rate of 5 lpm. The pump is housed in a 9 Fr. catheter. There is currently no introducer sheath made for the device, so its use requires a surgical cut down to gain a 21 Fr. access point in the femoral artery. It looks like the percutaneous method was used, code 92970, cannot bill co-surgeons. Use of the Impella 2.5 to support a patient’s hemodynamic function may be a covered service if it meets all of the requirements established by Medicare and private payers. Payment of claims depends on proof of medical necessity based on documented evidence of signs, symptoms, risk factors, and medical history. Contact the payer for further instruction.

CPT code help

Thank you.