CPT® Code 0411T

Official Description

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

Common Language Description

The CPT® Code 0411T refers to the procedure involving the insertion or replacement of a permanent cardiac contractility modulation (CCM) system, specifically focusing on the ventricular electrode only. This procedure is primarily indicated for patients suffering from moderate to severe chronic heart failure. The CCM system is designed to enhance cardiac muscle contractility by delivering electrical impulses during the absolute refractory period of the cardiac cycle. These impulses are non-excitatory, meaning they do not alter the heart's rhythm but instead modulate the strength of the muscle contractions, thereby improving overall cardiac function. 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 covers the insertion or replacement of the entire CCM system, including both the pulse generator and transvenous electrodes, and 0409T, which pertains solely to the pulse generator. Code 0410T is specific to the insertion or replacement of the atrial electrode only, while 0411T is dedicated to the ventricular electrode insertion or replacement.

1. Indications

The procedure associated with CPT® Code 0411T is indicated for patients with the following conditions:

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.

2. Procedure

The procedure for the insertion or replacement of a permanent cardiac contractility modulation (CCM) system, specifically the ventricular electrode, involves several detailed steps:

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: Venous Access - The right subclavian, cephalic, or axillary vein is identified and accessed using a plastic sheath. This step is crucial for facilitating the insertion of the electrodes into the heart.
Step 3: Electrode Insertion - Electrodes, also known as pacemaker lead wires, are inserted through the sheath and advanced under fluoroscopy guidance to ensure accurate placement within the heart. This imaging technique helps visualize the electrodes' path and position.
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 testing ensures that the system is operational before final placement.
Step 6: Contractility Evaluation - If performed, a contractility evaluation is 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 patient's specific needs and condition.
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 may also receive instructions regarding activity restrictions and signs of potential complications, such as infection or lead displacement, that should prompt immediate medical attention.

Short Descr	INSJ/RPLC CAR MODULJ VNT ELT
Medium Descr	INSJ/RPLC CAR MODULJ SYS VENTR 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; ventricular 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	Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
Berenson-Eggers TOS (BETOS)	P2E - Major procedure, cardiovascular-Pacemaker insertion
MUE	1