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Official Description

Laparoscopic insertion of new or replacement of permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, including an implantable pulse generator and diaphragmatic lead(s)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 0674T involves the laparoscopic insertion of a new or replacement permanent implantable synchronized diaphragmatic stimulation (SDS) system, which is designed to augment cardiac function. This innovative system is particularly beneficial for patients suffering from moderate to severe heart failure, especially when there is preserved ventricular synchrony. The primary function of the SDS system is to stimulate the diaphragm in synchronization with the cardiac cycle, which helps modify chest pressure. This modification facilitates improved filling and emptying of the heart, ultimately enhancing blood flow without placing additional stress on the heart muscle. The system comprises an implantable pulse generator, bipolar active fixation leads, and programming software, all of which work together to optimize cardiac function. During the procedure, a minimally invasive laparoscopic approach is utilized, involving the creation of two small half-inch incisions. Through these incisions, two bipolar leads are implanted on the underside of the diaphragm. Additionally, a small subcutaneous pocket is formed in the abdomen to accommodate the pulse generator, which is responsible for detecting cardiac activity. The leads are then connected to the pulse generator, which delivers a small electrical shock to stimulate a specific area of the diaphragm, ensuring that normal breathing is not affected. This procedure is reported using CPT® Code 0674T when the entire system is implanted or completely replaced. For cases where only the first new diaphragmatic lead is placed or an existing lead is replaced and connected to an already positioned pulse generator, CPT® Code 0675T is used. Furthermore, CPT® Code 0676T is designated for the placement or replacement of each additional lead beyond the first.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The laparoscopic insertion of a permanent implantable synchronized diaphragmatic stimulation (SDS) system is indicated for patients with moderate to severe heart failure, particularly in cases where there is preserved ventricular synchrony. This procedure is aimed at enhancing cardiac function by improving the efficiency of the heart's pumping ability through diaphragmatic stimulation.

  • Moderate to Severe Heart Failure The procedure is specifically indicated for patients experiencing moderate to severe heart failure, where traditional treatments may not be sufficient to improve cardiac function.
  • Preserved Ventricular Synchrony The SDS system is utilized in cases where the patient's ventricular synchrony is preserved, allowing for effective stimulation of the diaphragm in sync with the cardiac cycle.

2. Procedure

The laparoscopic insertion of the SDS system involves several key procedural steps that ensure the successful implantation of the device.

  • Step 1: Preparation and Anesthesia The patient is prepared for the procedure, which includes administering general anesthesia to ensure comfort and immobility during the surgery.
  • Step 2: Incision Creation Two small half-inch incisions are made in the abdominal area to facilitate access for the laparoscopic instruments. These incisions are strategically placed to minimize tissue damage and promote quicker recovery.
  • Step 3: Lead Implantation Through the incisions, two bipolar active fixation leads are carefully implanted on the underside of the diaphragm. This step is crucial as the leads will be responsible for delivering electrical stimulation to the diaphragm.
  • Step 4: Pulse Generator Placement A small subcutaneous pocket is created in the abdomen to house the implantable pulse generator. This device is essential for detecting cardiac activity and sending electrical impulses to the diaphragm.
  • Step 5: Connection of Leads to Pulse Generator The implanted leads are then connected to the pulse generator. This connection allows the pulse generator to send small electrical shocks to stimulate the diaphragm in sync with the heart's activity.
  • Step 6: Closure of Incisions After ensuring that all components are properly placed and functioning, the incisions are closed using sutures or surgical adhesive, completing the procedure.

3. Post-Procedure

Following the laparoscopic insertion of the SDS system, patients are typically monitored for a short period to ensure there are no immediate complications. Post-procedure care may include pain management, instructions for activity restrictions, and follow-up appointments to assess the functionality of the device. Patients can expect a recovery period during which they may gradually resume normal activities, with specific guidance provided by their healthcare provider. It is important for patients to report any unusual symptoms or concerns during their recovery to ensure proper management and support.

Short Descr LAPS INSJ NW/RPCMT PRM ISDSS
Medium Descr LAPS INSJ NEW/RPLCMT PERM ISDSS AGMNTJ CAR FUNCJ
Long Descr Laparoscopic insertion of new or replacement of permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, including an implantable pulse generator and diaphragmatic lead(s)
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) 1 - Statutory 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) none
MUE 1
Date
Action
Notes
2022-01-01 Added Code added
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