CPT® Code 0409T

Official Description

Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; pulse generator only

Common Language Description

The CPT® Code 0409T refers to the procedure involving the insertion or replacement of a permanent cardiac contractility modulation (CCM) system, specifically focusing on the pulse generator component. This procedure is primarily indicated for patients suffering from moderate to severe chronic heart failure. The CCM system operates by generating electrical impulses during the absolute refractory period of the cardiac cycle, which enhances the contractility of the heart muscle. Importantly, these impulses are non-excitatory, meaning they improve the strength of the heart's contractions without altering the heart's rhythm. The procedure begins with a small incision made in the right pectoral region, where a pocket is created to house the pulse generator. Access to the heart is achieved through the right subclavian, cephalic, or axillary vein using a plastic sheath. Through this sheath, electrodes, also known as pacemaker lead wires, are inserted and guided under fluoroscopy to the heart. The positioning of the sensing lead occurs in the right atrium, while two CCM transmission leads are placed in the upper and middle regions of the right ventricular septum. After connecting the leads to the pulse generator, their location and functionality are tested to ensure proper operation. 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. This procedure is distinct from other related codes, such as 0408T, which encompasses the insertion or replacement of the entire CCM system, including transvenous electrodes, while 0410T and 0411T pertain to the insertion or replacement of the atrial and ventricular electrodes, respectively.

1. Indications

The procedure associated with CPT® Code 0409T is indicated for patients with 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 use of a permanent cardiac contractility modulation (CCM) system aims to improve the contractility of the heart muscle, thereby enhancing the overall cardiac function and quality of life for these patients.

Chronic Heart Failure Patients with moderate to severe chronic heart failure who require improved cardiac contractility.

2. Procedure

The procedure for the insertion or replacement of a permanent cardiac contractility modulation system, as described by CPT® Code 0409T, involves several critical steps to ensure proper placement and functionality of the device.

Step 1: Incision and Pocket Creation A small incision is made in the right pectoral region to create a pocket for the pulse generator. This incision allows access to the underlying tissues where the device will be implanted.
Step 2: Vein Access The right subclavian, cephalic, or axillary vein is identified and accessed using a plastic sheath. This access is crucial for the subsequent placement of the electrodes.
Step 3: Electrode Insertion Electrodes, also known as pacemaker lead wires, are inserted through the sheath and advanced under fluoroscopy to ensure accurate positioning within the heart. This step is vital for the effective functioning of the CCM system.
Step 4: Lead Positioning The sensing lead is positioned in the right atrium, while two CCM transmission leads are placed in the upper and middle regions of the right ventricular septum. Proper lead placement is essential for optimal device performance.
Step 5: Connection and Testing The leads are connected to the pulse generator, and both the leads and the pulse generator are tested to verify their location and functionality. This testing ensures that the device is working correctly before final placement.
Step 6: Contractility Evaluation If performed, a contractility evaluation is conducted to assess the heart's response to the CCM system. This evaluation helps in programming the device for optimal therapeutic outcomes.
Step 7: Programming The pulse generator is programmed for sensing and therapeutic parameters based on the evaluation results. This programming is crucial for tailoring the device's function to the patient's needs.
Step 8: Final Placement and Closure The pulse generator is placed in the previously created pocket, and the incision is closed with sutures, completing the procedure.

3. Post-Procedure

After the procedure, patients may require monitoring to assess the functionality of the implanted CCM system and to ensure there are no immediate complications. Follow-up appointments are typically scheduled to evaluate the device's performance and make any necessary adjustments to the programming. Patients may also receive instructions regarding activity restrictions and signs of potential complications, such as infection or lead displacement, that should prompt immediate medical attention. Recovery time can vary, but patients are generally advised to avoid strenuous activities for a period following the procedure to allow for proper healing.

Short Descr	INSJ/RPLC CAR MODULJ PLS GN
Medium Descr	INSJ/RPLC CARDIAC MODULJ SYS PLS GENERATOR ONLY
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 only
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