CPT® Code 0416T

Official Description

Relocation of skin pocket for implanted cardiac contractility modulation pulse generator

Common Language Description

The procedure described by CPT® Code 0416T involves the relocation of a skin pocket for an implanted cardiac contractility modulation (CCM) pulse generator. This procedure is performed when there is a need to reposition a previously implanted permanent CCM system, which includes a transvenous electrode that can be either an atrial or ventricular lead. 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 muscle contractions. The process begins with making an incision in the skin to access the pulse generator of the CCM system. The transvenous lead electrode is then disconnected from the pulse generator and repositioned under fluoroscopic guidance to ensure optimal placement. After the lead is correctly positioned, it is reconnected to the pulse generator, and the incision is sutured closed. In cases where the pulse generator itself needs to be relocated, a new skin pocket is created by making an incision near the existing pulse generator site. The pulse generator, along with the electrodes, is then carefully tunneled to the new pocket location, and the incision is subsequently closed with sutures. This procedure is essential for maintaining the functionality of the CCM system and ensuring effective treatment for patients with specific cardiac conditions.

1. Indications

The relocation of the skin pocket for an implanted cardiac contractility modulation pulse generator, as described by CPT® Code 0416T, is indicated in the following scenarios:

Repositioning of Electrode: When there is a need to reposition a previously implanted transvenous electrode (atrial or ventricular lead) to optimize its placement for effective cardiac contractility modulation.
Pulse Generator Relocation: When the existing skin pocket for the pulse generator requires relocation due to complications such as infection, discomfort, or anatomical changes that necessitate a new site for the pulse generator.

2. Procedure

The procedure for relocating the skin pocket for the implanted cardiac contractility modulation pulse generator involves several detailed steps:

Step 1: Incision and Access An incision is made in the skin near the existing pulse generator to provide access to the CCM system. This incision allows the healthcare provider to expose the pulse generator and the associated electrodes.
Step 2: Disconnecting the Electrode The transvenous lead electrode, which can be either an atrial or ventricular lead, is carefully disconnected from the pulse generator. This step is crucial to ensure that the electrode can be repositioned without any interference from the pulse generator.
Step 3: Repositioning the Electrode Under fluoroscopic guidance, the disconnected electrode is repositioned to an optimal location. This imaging technique helps the physician visualize the heart and the electrode's placement in real-time, ensuring accurate positioning.
Step 4: Reconnecting the Electrode Once the electrode is in the desired position, it is reconnected to the pulse generator. This step is essential for restoring the functionality of the CCM system.
Step 5: Creating a New Pocket If the pulse generator itself needs to be relocated, a new pocket is created in the subcutaneous tissue. This involves tunneling the pulse generator and electrodes to the new location.
Step 6: Closing the Incision After the pulse generator and electrodes have been successfully relocated, the incision is closed with sutures. This final step ensures that the surgical site is properly sealed to promote healing.

3. Post-Procedure

Post-procedure care for the relocation of the skin pocket for the implanted cardiac contractility modulation pulse generator includes monitoring the surgical site for signs of infection, ensuring proper healing of the incision, and assessing the functionality of the CCM system. Patients may be advised to avoid strenuous activities for a specified period to allow for optimal recovery. Follow-up appointments are typically scheduled to evaluate the positioning of the electrode and the overall performance of the CCM system, ensuring that it continues to provide the intended therapeutic benefits.

Short Descr	RELOC SKIN POCKET PLS GEN
Medium Descr	RELOC SKIN POCKET CARDIAC MODULJ PULSE GENERATOR
Long Descr	Relocation of skin pocket for implanted cardiac contractility modulation pulse generator
Status Code	Carriers Price the Code
Global Days	YYY - Carrier Determines Whether Global Concept Applies
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	2 - Standard 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	Procedure or Service, Multiple Reduction Applies
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

Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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).

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.