CPT® Code 0527T

1. Indications

The intracardiac ischemia monitoring system is indicated for patients with a prior history of acute coronary syndrome, which includes:

• Myocardial Infarction (MI) - A condition where blood flow to a part of the heart is blocked, causing damage to the heart muscle.
• Unstable Angina - A type of chest pain that occurs unpredictably and may signal an impending heart attack, indicating a high risk for recurrent cardiac events.

2. Procedure

The procedure for the insertion or replacement of the intracardiac ischemia monitoring system involves several critical steps:

• Step 1: Venous Access - The procedure begins with obtaining venous access for the insertion of the EKG electrode. This can be achieved through a standard percutaneous puncture of the subclavian vein or by employing a cut down technique to access the cephalic vein.
• Step 2: Guidewire Insertion - Under fluoroscopic guidance, a guidewire is inserted into the chosen vessel and advanced toward the right ventricle, ensuring accurate placement for the subsequent steps.
• Step 3: Vascular Sheath Introduction - A vascular sheath is then introduced over the guidewire into the right ventricle. Once the sheath is in place, the guidewire is removed, allowing for the next step in the procedure.
• Step 4: EKG Electrode Placement - The EKG electrode is threaded through the sheath and tested to ensure it captures cardiac electrical impulses effectively. Once optimal placement is confirmed, the electrode is anchored to the endocardium to secure it in position.
• Step 5: Electrode Wire Stabilization - To prevent migration of the electrode, the wire may be sutured in place at the site of vessel insertion.
• Step 6: Monitor Pocket Creation - A skin incision is made in the infraclavicular area, and a subcutaneous pocket is created to accommodate the implantable monitor.
• Step 7: Monitor Connection and Testing - The EKG electrode is connected to the monitor, which is then tested and programmed to ensure proper functionality before being inserted into the created pocket.

3. Post-Procedure

After the procedure, patients are typically monitored for any immediate complications related to the insertion. The expected recovery involves observing the surgical site for signs of infection or other adverse reactions. Patients may receive instructions on how to care for the incision site and when to seek medical attention if they experience any unusual symptoms. Regular follow-up appointments may be necessary to ensure the monitoring system is functioning correctly and to assess the patient's overall cardiac health.