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A permanent cardiac contractility modulation (CCM) system is a specialized medical device designed for patients suffering from moderate to severe chronic heart failure. This system functions by generating electrical impulses that are delivered to the heart muscle during the absolute refractory period of the cardiac cycle. The primary purpose of these impulses is to enhance the contractility of the heart muscle, thereby improving its ability to pump blood effectively. Importantly, these electrical impulses are non-excitatory, meaning they do not alter the heart's rhythm; instead, they modulate the strength of the muscle contractions. The procedure for inserting or replacing a CCM system involves creating a small incision in the right pectoral region to form a pocket for the pulse generator. Access to the heart is achieved through the right subclavian, cephalic, or axillary vein using a plastic sheath. Electrodes, also known as pacemaker lead wires, are then inserted through this sheath and guided under fluoroscopy to the heart. The positioning of the sensing lead in the right atrium and the two CCM transmission leads in the right ventricular septum is critical for the system's functionality. After connecting the leads to the pulse generator, their location and operational integrity are verified. If necessary, a contractility evaluation is performed, and the pulse generator is programmed to establish the appropriate sensing and therapeutic parameters. Finally, the pulse generator is securely placed in the previously created pocket, and the incision is closed with sutures. The CPT® Code 0408T specifically reports the insertion or replacement of the complete CCM system, including the pulse generator and transvenous electrodes, along with any programming and evaluation performed during the procedure.
© Copyright 2025 Coding Ahead. All rights reserved.
The insertion or replacement of a permanent cardiac contractility modulation (CCM) system is indicated for patients who are experiencing moderate to severe chronic heart failure. This condition is characterized by the heart's inability to pump blood effectively, leading to symptoms such as fatigue, shortness of breath, and fluid retention. The CCM system is specifically designed to improve cardiac contractility in these patients, thereby enhancing their overall heart function and quality of life.
The procedure for the insertion or replacement of a permanent cardiac contractility modulation (CCM) system involves several critical steps to ensure proper placement and functionality of the device. Initially, a small incision is made in the right pectoral region to create a pocket for the pulse generator. This incision allows for direct access to the underlying tissues where the pulse generator will be implanted. Following this, the right subclavian, cephalic, or axillary vein is identified and accessed using a plastic sheath, which serves as a conduit for the insertion of the electrodes. Under fluoroscopic guidance, electrodes, also known as pacemaker lead wires, are carefully inserted through the sheath and advanced towards the heart. The positioning of the sensing lead is crucial, as it is placed in the right atrium, while the two CCM transmission leads are positioned in the upper and middle regions of the right ventricular septum. Once the leads are correctly positioned, they are connected to the pulse generator. At this stage, the leads and the pulse generator undergo testing to verify their location and functionality, ensuring that the system will operate as intended. If indicated, a contractility evaluation may be performed to assess the heart's response to the modulation. Subsequently, the pulse generator is programmed to establish the appropriate sensing and therapeutic parameters tailored to the patient's needs. Finally, the pulse generator is placed securely in the previously created pocket, and the incision is closed with sutures, completing the procedure.
After the insertion or replacement of the permanent cardiac contractility modulation (CCM) system, patients are typically monitored for any immediate complications related to the procedure. Post-procedure care may include pain management, monitoring for signs of infection at the incision site, and ensuring that the device is functioning correctly. Patients may be advised on activity restrictions to allow for proper healing of the incision and to prevent dislodgment of the leads. Follow-up appointments are essential to assess the device's performance and make any necessary adjustments to the programming of the pulse generator. Additionally, patients may undergo regular evaluations to monitor their heart function and overall health status following the procedure.
| Short Descr | INSJ/RPLC CARDIAC MODULJ SYS | Medium Descr | INSJ/RPLC CAR MODULJ SYS PLS GEN TRANSVNS ELTRD | Long Descr | Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; pulse generator with transvenous electrodes | 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 | ASC Payment Indicator | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | Berenson-Eggers TOS (BETOS) | P2E - Major procedure, cardiovascular-Pacemaker insertion | MUE | 1 |
| Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AO | Alternate payment method declined by provider of service | GC | This service has been performed in part by a resident under the direction of a teaching physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | KX | Requirements specified in the medical policy have been met | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter |
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| 2017-01-01 | Added | First appearance in codebook. |
| 2016-01-01 | Added | Added |
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