CPT® Code 0413T

Official Description

Removal of permanent cardiac contractility modulation system; transvenous electrode (atrial or ventricular)

Common Language Description

The procedure described by CPT® Code 0413T involves the removal of a permanent cardiac contractility modulation (CCM) system, specifically focusing on the transvenous electrode, which can be either atrial or ventricular. The CCM system is utilized in patients suffering from moderate to severe chronic heart failure, a condition where the heart is unable to pump blood effectively. This system works 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 do not alter the heart's rhythm but instead modulate the strength of the muscle contractions. The removal process requires a surgical incision to access the pulse generator, which is the device that produces these electrical impulses. Once the pulse generator is exposed, the electrode is disconnected and removed, followed by the closure of the incision with sutures. This procedure is critical for patients who may need to replace or discontinue the use of the CCM system due to various clinical reasons.

1. Indications

The removal of a permanent cardiac contractility modulation system, as indicated by CPT® Code 0413T, is performed in patients with specific conditions related to chronic heart failure. The following indications are explicitly associated with this procedure:

Moderate to Severe Chronic Heart Failure - Patients diagnosed with moderate to severe chronic heart failure may require the removal of the CCM system due to complications, device malfunction, or a change in treatment strategy.

2. Procedure

The procedure for the removal of the transvenous electrode of the cardiac contractility modulation system involves several critical steps, which are detailed as follows:

Step 1: Incision - The procedure begins with the surgeon making an incision in the skin to access the pulse generator of the CCM system. This incision is strategically placed to ensure optimal exposure of the device.
Step 2: Disconnection of the Electrode - Once the pulse generator is exposed, the next step involves disconnecting the transvenous electrode, which can be either atrial or ventricular, from the pulse generator. This step is crucial as it ensures that the electrode can be safely removed without damaging surrounding tissues.
Step 3: Removal of the Electrode - After disconnection, the electrode is carefully removed from the body. This step requires precision to avoid any complications during the extraction process.
Step 4: Closure of the Incision - Following the successful removal of the electrode, the final step involves closing the incision with sutures. This ensures that the surgical site is properly sealed to promote healing and reduce the risk of infection.

3. Post-Procedure

Post-procedure care following the removal of the transvenous electrode includes monitoring the patient for any signs of complications, such as infection or bleeding at the incision site. Patients may also be advised on wound care and activity restrictions to facilitate proper healing. Follow-up appointments are typically scheduled to assess recovery and determine if any further interventions are necessary.

Short Descr	RMVL CAR MODULJ TRANVNS ELT
Medium Descr	REMOVAL CARDIAC MODULJ SYS TRANSVENOUS ELECTRODE
Long Descr	Removal of permanent cardiac contractility modulation system; transvenous electrode (atrial or 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	T-Packaged Codes
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

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.
GC	This service has been performed in part by a resident under the direction of a teaching physician
XS	Separate structure, a service that is distinct because it was performed on a separate organ/structure