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The CPT® Code 0304T refers to the procedure involving the insertion, removal, and replacement of an intracardiac ischemia monitoring system, which is a specialized device designed to monitor electrocardiogram (ECG) changes, specifically focusing on ST segment alterations in real time. This monitoring system plays a critical role in alerting patients to seek immediate medical attention during cardiac ischemic events, which may not always present with typical warning signs such as chest pain, shortness of breath, nausea, or diaphoresis (sweating). The device is particularly beneficial for individuals who may not experience or recognize these symptoms, thereby potentially reducing the time it takes for them to present to an emergency room following an ischemic event. The intracardiac ischemia monitoring system consists of several components, including a programmable implantable monitoring device (IMD), a right ventricular lead wire, a lead wire adapter, an external alarm device (EXD), and a programming unit. The procedure for inserting the device typically occurs in a cardiac catheterization lab under monitored anesthesia care (MAC) or moderate sedation. During the procedure, a local anesthetic is administered to the upper left chest area, followed by a 2-3 inch skin incision. Using fluoroscopy, the lead wire is carefully advanced through a vein to the apex of the right ventricle, where it is connected to the IMD. The IMD is then programmed, inserted into the chest incision, tested for functionality, and the incision is closed with sutures. When the device detects a ten-second electrocardiogram that deviates from the programmed baseline, the EXD activates an alarm through vibrations, flashing lights, and/or audible beeps, prompting the patient to seek urgent medical care. Additionally, the data collected by the device can be retrieved and analyzed by the treating physician, providing valuable insights into the patient's cardiac health. This monitoring system is particularly recommended for patients with a history of acute coronary events, diabetes, or renal insufficiency, as they are considered high-risk for ischemic cardiac events.
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High-Risk Patients The intracardiac ischemia monitoring system is indicated for use in patients who have a history of acute coronary events, diabetes, or renal insufficiency, as these individuals are at an elevated risk for experiencing ischemic cardiac events.
Step 1: Preparation The procedure begins with the patient being positioned in the cardiac catheterization lab, where monitored anesthesia care (MAC) or moderate sedation is administered. A local anesthetic is injected into the upper left chest area to minimize discomfort during the procedure.
Step 2: Incision Following the administration of anesthesia, the physician makes a skin incision approximately 2-3 inches long in the upper left chest area. This incision provides access to the underlying tissues and structures necessary for the placement of the monitoring device.
Step 3: Lead Wire Advancement Using fluoroscopy for guidance, the physician advances the right ventricular lead wire through a vein to the apex of the right ventricle. This step is crucial as it ensures proper placement of the lead wire, which is essential for accurate monitoring of the heart's electrical activity.
Step 4: Device Connection and Programming Once the lead wire is positioned correctly, it is attached to the programmable implantable monitoring device (IMD). The IMD is then programmed to establish baseline parameters for monitoring the patient's electrocardiogram (ECG) changes.
Step 5: Device Insertion and Testing After programming, the IMD is inserted into the chest through the incision. The device is tested to ensure it is functioning correctly and is capable of monitoring the patient's heart activity as intended.
Step 6: Closure Once the device is confirmed to be operational, the physician closes the skin incision with sutures, completing the procedure. The patient is then monitored for any immediate post-operative complications.
After the procedure, patients are typically monitored for any adverse reactions or complications related to the insertion of the intracardiac ischemia monitoring system. The expected recovery period may vary depending on the individual patient's health status and the complexity of the procedure. Patients are advised to follow up with their healthcare provider for device interrogation and programming adjustments as needed. Additionally, they should be educated on the function of the external alarm device (EXD) and instructed on how to respond to alarms indicating potential cardiac ischemic events.
| Short Descr | ICAR ISCHM MNTRNG SYS DEVICE | Medium Descr | INSJ/RMVL RPLCMT ICAR ISCHM MNTRNG SYS DEVICE | Long Descr | Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative interrogation and programming when performed; device only | Status Code | Carriers Price the Code | Global Days | YYY - Carrier Determines Whether Global Concept Applies | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | Not applicable/unspecified. | CCS Clinical Classification | 49 - Other OR heart procedures |
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| 2018-01-01 | Deleted | Code deleted |
| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2013-01-01 | Changed | Guideline information changed. |
| 2013-01-01 | Added | First appearance in codebook. |
| 2012-07-01 | Added | Added |
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