CPT® Code 0410T

Official Description

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

Common Language Description

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 operates by generating electrical impulses that are delivered 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 impulses are non-excitatory, meaning they modulate the strength of the heart's contractions without altering the heart's rhythm. The procedure for inserting or replacing a CCM system involves making a small incision in the right pectoral region to create a pocket for the pulse generator. Access to the heart is achieved by identifying and accessing 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 sensing lead is strategically positioned 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, the placement and functionality of the leads and generator are tested. If indicated, a contractility evaluation may be 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 critical for patients who require enhanced cardiac function due to their heart failure condition.

1. Indications

The insertion or replacement of a permanent cardiac contractility modulation (CCM) system is indicated for patients with the following conditions:

Moderate to Severe Chronic Heart Failure Patients who are experiencing significant limitations in their ability to perform daily activities due to heart failure symptoms.

2. Procedure

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.

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 for direct access to the area 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 insertion of the electrodes into the heart.
Step 3: Electrode Insertion Electrodes, also referred to as pacemaker lead wires, are inserted through the sheath and advanced under fluoroscopy guidance to ensure accurate placement within the heart.
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 positioning of these leads is essential for the effective functioning of the CCM system.
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 step ensures that the device is working correctly before final placement.
Step 6: Contractility Evaluation If performed, a contractility evaluation may be conducted to assess the heart's response to the electrical impulses generated by the CCM system.
Step 7: Programming The pulse generator is programmed for sensing and therapeutic parameters, which are tailored to the individual 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 will typically be scheduled to evaluate the device's performance and make any necessary adjustments to the programming. Patients should be informed about signs of potential complications, such as infection at the incision site or issues with the device itself, and instructed to report any concerning symptoms to their healthcare provider. Recovery time may vary, but patients are generally advised to avoid strenuous activities for a specified period to allow for proper healing.

Short Descr	INSJ/RPLC CAR MODULJ ATR ELT
Medium Descr	INSJ/RPLC CARDIAC MODULJ SYS ATR ELECTRODE ONLY
Long Descr	Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; atrial electrode 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