CPT® Code 0328T

Deleted

1. Indications

The programming device evaluation with iterative adjustment of the implantable subcutaneous lead defibrillator system is indicated for patients who require monitoring and optimization of their cardiac device functionality. This procedure is typically performed in the following scenarios:

• Assessment of Device Functionality Patients may present for evaluation to ensure that the defibrillator is functioning correctly and to identify any potential issues with the device.
• Review of Cardiac Rhythm The procedure is indicated for patients experiencing abnormal cardiac rhythms or those who have had episodes of tachyarrhythmia that need to be analyzed and addressed.
• Adjustment of Pacing Parameters Patients requiring adjustments to their pacing settings based on previous evaluations or changes in their clinical status may benefit from this procedure.
• Evaluation of Hemodynamics The procedure is indicated for patients needing assessment of hemodynamic responses to pacing and adjustments to optimize cardiac output.

2. Procedure

The programming device evaluation involves several critical procedural steps to ensure the effective functioning of the implantable subcutaneous lead defibrillator system. Each step is designed to gather essential data and make necessary adjustments.

• Step 1: Patient Connection The patient is connected to an electrocardiogram (ECG) monitor to continuously assess cardiac rhythm throughout the procedure. This connection is crucial for real-time monitoring and evaluation.
• Step 2: Device Interrogation A connection is established between the implantable defibrillator system and the programming device. The electrophysiologist interrogates the device to retrieve stored data related to cardiac rhythm and any tachyarrhythmia episodes. This data is compared with previous acquisitions to identify any changes or trends.
• Step 3: Assessment of Pacing Capture Threshold The pacing capture threshold is assessed to determine the minimum electrical stimulus required to achieve effective pacing. This assessment is vital for ensuring that the device can reliably stimulate the heart.
• Step 4: Evaluation of Pacing Function The pacing function is thoroughly evaluated, including the integrity of the leads and the battery status of the device. Any issues identified during this evaluation are addressed to maintain device reliability.
• Step 5: Sensing Threshold Evaluation The sensing threshold data is reviewed to ensure that the device can accurately detect the heart's electrical activity. This evaluation is essential for the device's ability to respond appropriately to the patient's cardiac needs.
• Step 6: Iterative Programming Process An iterative programming process is employed to adjust the programmed parameters based on the effects of programming on multiple variables, including ventricular pacing and hemodynamics. This process allows for fine-tuning of the device settings to achieve optimal performance.
• Step 7: Review of Exercise and Physiological Stress Data The electrophysiologist reviews data related to exercise and physiological stress to observe heart rate adaptations. This information is critical for making informed adjustments to the device settings.
• Step 8: Final Adjustments and Reporting After careful evaluation of all variables, programmed parameters are adjusted as needed. The patient is informed of the findings, and a written report is provided, including any instructions for follow-up services or procedures.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate reactions to the adjustments made during the programming evaluation. The patient is provided with a written report detailing the findings and any changes made to the device settings. Instructions regarding follow-up services or procedures are given to ensure ongoing monitoring and management of the patient's condition. It is essential for the patient to adhere to these follow-up instructions to maintain optimal device performance and overall cardiac health.