CPT® Code 0387T | Case2Code

Code deleted, see 33274, 33275

Official Description

Transcatheter insertion or replacement of permanent leadless pacemaker, ventricular

Common Language Description

The procedure described by CPT® Code 0387T involves the transcatheter insertion or replacement of a permanent leadless pacemaker specifically designed for ventricular pacing. A leadless pacemaker is a compact device that integrates a pulse generator, battery, and electrode into a single unit, eliminating the need for traditional leads that connect the pacemaker to the heart. This innovative approach is particularly beneficial for patients suffering from arrhythmias, such as atrial fibrillation and atrioventricular heart block, as it allows for effective pacing of the heart's ventricles without the complications associated with lead placement. The procedure is performed using fluoroscopic guidance, which provides real-time imaging to ensure accurate placement of the device. Access to the right ventricle is achieved through the femoral vein, utilizing either a percutaneous or cut-down technique to insert a large diameter sheath. This sheath facilitates the delivery of the pacemaker to the apex of the right ventricle, where it is anchored securely to the heart tissue. The procedure also includes the option for removal of the pacemaker using a catheter-based snare system, ensuring that the device can be retrieved safely when necessary. Overall, this procedure represents a significant advancement in cardiac pacing technology, offering a less invasive alternative for patients requiring ventricular pacing support.

1. Indications

The transcatheter insertion or replacement of a permanent leadless pacemaker is indicated for patients who require single chamber ventricular pacing due to specific cardiac conditions. These conditions include:

Atrial Fibrillation - A common arrhythmia characterized by an irregular and often rapid heart rate, which can lead to poor blood flow and increased risk of stroke.
Atrioventricular Heart Block - A condition where the electrical signals between the atria and ventricles of the heart are impaired, leading to a slower heart rate and potential symptoms of fatigue, dizziness, or syncope.

2. Procedure

The procedure for the transcatheter insertion or replacement of a permanent leadless pacemaker involves several critical steps:

Step 1: Accessing the Femoral Vein - The procedure begins with the patient positioned appropriately, and the femoral vein is accessed using either a percutaneous approach or a cut-down technique. This access point is crucial for advancing the necessary equipment to the heart.
Step 2: Upsizing the Sheath - Once the femoral vein is accessed, it is upsized to accommodate a large diameter sheath. This sheath is essential for the subsequent delivery of the pacemaker to the right ventricle.
Step 3: Advancing the Sheath - The sheath is carefully advanced through the femoral vein and navigated to the apex of the right ventricle. Fluoroscopic guidance is utilized throughout this process to ensure accurate positioning.
Step 4: Delivering the Pacemaker - A steerable catheter is inserted through the sheath, allowing for the precise delivery of the leadless pacemaker across the tricuspid valve. The pacemaker is then anchored to the ventricular endocardium using a screw helix or prongs, ensuring stability within the heart.
Step 5: Finalizing the Procedure - After the pacemaker is securely positioned, the delivery catheter is withdrawn, and the sheath is removed. The incision site is then closed to complete the procedure.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate complications and ensuring proper recovery. Patients may be observed for signs of infection at the incision site or any issues related to the pacemaker's function. Follow-up appointments are typically scheduled to assess the pacemaker's performance and make any necessary adjustments. Patients are also educated on activity restrictions and signs of potential complications that should prompt immediate medical attention.

Short Descr	LEADLESS PM INS/RPL VENTR
Medium Descr	TRANSCATH INSERT OR REPLACE LEADLESS PM VENTR
Long Descr	Transcatheter insertion or replacement of permanent leadless pacemaker, ventricular
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No 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)	0 - 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
Berenson-Eggers TOS (BETOS)	I4A - Imaging/procedure - heart including cardiac catheter
MUE	Not applicable/unspecified.