CPT® Code 0678T | Case2Code

Official Description

Laparoscopic repositioning of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, including connection to an existing pulse generator; each additional repositioned lead (List separately in addition to code for primary procedure)

Common Language Description

The CPT® Code 0678T refers to the laparoscopic repositioning of additional diaphragmatic lead(s) as part of a permanent implantable synchronized diaphragmatic stimulation (SDS) system. This advanced medical procedure is designed to enhance cardiac function, particularly in patients suffering from moderate to severe heart failure while maintaining preserved ventricular synchrony. The SDS system operates by stimulating the diaphragm in synchronization with the heart's natural rhythm, which helps to 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 itself. The system comprises two bipolar active fixation leads that are implanted on the underside of the diaphragm, a pulse generator that detects cardiac activity, and programming software to manage the device's operation. The procedure is performed using a minimally invasive laparoscopic technique, which involves making two small incisions, each approximately half an inch in length, to access the diaphragm for lead implantation. Additionally, a subcutaneous pocket is created in the abdominal area to accommodate the pulse generator. The stimulation provided by the leads is carefully calibrated to target a specific area of the diaphragm, ensuring that normal breathing is not affected. This code is specifically used for reporting each additional lead that is repositioned, following the repositioning of the first lead, which is reported under CPT® Code 0677T. The repositioning may be necessary due to various factors such as lead movement, malpositioning, infection, hematoma, or discomfort at the original site. Proper evaluation and manipulation of the lead's position are critical to ensure optimal functioning of the SDS system.

1. Indications

The laparoscopic repositioning of diaphragmatic lead(s) using CPT® Code 0678T is indicated for patients who have a permanent implantable synchronized diaphragmatic stimulation (SDS) system and require adjustments to the positioning of their existing leads. The specific indications for this procedure include:

Lead Movement - The lead may have shifted from its original position, necessitating repositioning to ensure effective stimulation of the diaphragm.
Malpositioning - If the lead is not correctly placed against the diaphragm, it may not function optimally, requiring repositioning to restore proper function.
Infection - The presence of infection at the lead site may require repositioning to a new site to prevent further complications.
Hematoma - Accumulation of blood (hematoma) at the lead site may necessitate repositioning to ensure the lead is functioning correctly and to alleviate any associated symptoms.
Pain and Discomfort - Patients experiencing pain or discomfort at the existing lead site may require repositioning to improve their comfort and the overall effectiveness of the stimulation system.

2. Procedure

The procedure for laparoscopic repositioning of diaphragmatic lead(s) involves several critical steps to ensure the successful adjustment of the leads. The steps are as follows:

Step 1: Preparation - The patient is positioned appropriately, and the surgical area is prepared and sterilized to minimize the risk of infection. Anesthesia is administered to ensure the patient is comfortable throughout the procedure.
Step 2: Incision Creation - Two small incisions, each approximately half an inch in length, are made in the abdominal area to allow access to the diaphragm. These incisions are strategically placed to facilitate the laparoscopic approach.
Step 3: Lead Evaluation - A laparoscope is inserted through one of the incisions to visualize the existing diaphragmatic lead. The position and placement of the lead are carefully evaluated to determine if repositioning is necessary.
Step 4: Lead Manipulation - If the lead is found to be malpositioned, it is gently manipulated into the correct position against the underside of the diaphragm. This step is crucial for ensuring optimal stimulation of the diaphragm.
Step 5: Hematoma Management - If a hematoma is present, it is evacuated to clear the area and facilitate proper lead placement. This step helps to ensure that the lead can function without obstruction.
Step 6: Infection Control - In cases where infection is detected, the area may be flushed with an antibiotic solution to reduce the risk of complications and promote healing.
Step 7: Testing Lead Connection - Once the lead is repositioned, it is connected to the existing pulse generator. The connection is tested to ensure that the lead and generator are functioning properly before concluding the procedure.
Step 8: Closure - After confirming the proper functioning of the leads and generator, the laparoscope is removed, and the incisions are closed appropriately.

3. Post-Procedure

Following the laparoscopic repositioning of diaphragmatic lead(s), patients are typically monitored for any immediate complications. Post-procedure care may include pain management and instructions for activity restrictions to promote healing. Patients may be advised to avoid strenuous activities for a specified period to ensure proper recovery. Follow-up appointments are essential to assess the functionality of the repositioned leads and to monitor for any signs of infection or other complications. The healthcare provider will also evaluate the overall effectiveness of the synchronized diaphragmatic stimulation system in improving cardiac function.

Short Descr	LAPS REPOS LEAD ISDSS EA ADD
Medium Descr	LAPS REPOS LEAD PERM ISDSS EA ADDL REPOS LEAD
Long Descr	Laparoscopic repositioning of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, including connection to an existing pulse generator; each additional repositioned lead (List separately in addition to code for primary procedure)
Status Code	Carriers Price the Code
Global Days	ZZZ - Code Related to Another Service
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)	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	Items and Services Packaged into APC Rates
ASC Payment Indicator	Packaged service/item; no separate payment made.
Berenson-Eggers TOS (BETOS)	none
MUE	1

This is an add-on code that must be used in conjunction with one of these primary codes.

0677T

MPFS Status: Carrier Priced APC J1 ASC J8 Laparoscopic repositioning of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, including connection to an existing pulse generator; first repositioned lead