CPT® Code 0326T

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1. Indications

The electrophysiologic evaluation of a subcutaneous implantable defibrillator (CPT® Code 0326T) is indicated for patients who have received an S-ICD and require assessment of the device's functionality and effectiveness. The specific indications for this procedure include:

• Assessment of Device Functionality This evaluation is performed to ensure that the S-ICD is functioning correctly and can effectively detect and respond to arrhythmias.
• Defibrillation Threshold Evaluation The procedure is necessary to determine the minimum energy required for the device to successfully terminate a ventricular arrhythmia.
• Induction of Arrhythmia This step is crucial for testing the device's ability to sense and terminate induced ventricular tachycardia or fibrillation.
• Evaluation of Sensing for Arrhythmia Termination The procedure assesses the device's capability to accurately sense arrhythmias and deliver appropriate therapy.
• Programming or Reprogramming of Device Parameters This evaluation allows for adjustments to be made to the sensing and therapeutic parameters to optimize the device's performance.

2. Procedure

The procedure for the electrophysiologic evaluation of a subcutaneous implantable defibrillator involves several critical steps, each designed to ensure the device's optimal performance. The steps include:

• Preparation and Anesthesia The patient is prepared for the procedure under monitored anesthesia care (MAC), ensuring comfort and safety during the evaluation.
• Connection Integrity Testing An external programming unit is utilized to test the connection integrity between the electrode and the pulse generator, verifying that the device is properly connected and functioning.
• Induction of Ventricular Tachycardia If no contraindications are present, the patient is sedated, and ventricular tachycardia is induced to assess the device's response to arrhythmias.
• Monitoring Device Response Throughout the procedure, the device is monitored to ensure that it accurately senses the induced arrhythmia and that the energy level of the terminating shock falls within the device safety margin (DSM).
• Programming or Reprogramming Based on the evaluation results, the device may be programmed or reprogrammed to ensure that the sensing and therapeutic parameters are optimized for the patient's needs.

3. Post-Procedure

After the electrophysiologic evaluation of the subcutaneous implantable defibrillator, the patient is monitored for any immediate post-procedure complications. It is essential to ensure that the device is functioning correctly and that the patient is stable before discharge. Follow-up appointments may be scheduled to reassess the device's performance and make any necessary adjustments to the programming. Patients should be educated on signs of potential complications, such as unusual symptoms or device malfunctions, and instructed to seek medical attention if these occur. Overall, the post-procedure care focuses on ensuring the patient's safety and the effective operation of the S-ICD.