CPT® Code 0679T

Official Description

Laparoscopic removal of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function

Common Language Description

The procedure described by CPT® Code 0679T involves the laparoscopic removal of diaphragmatic lead(s) that are part of a permanent implantable synchronized diaphragmatic stimulation (SDS) system. This system is designed to augment cardiac function, particularly in patients suffering from moderate to severe heart failure while maintaining preserved ventricular synchrony. The SDS system works by stimulating the diaphragm in synchronization with the cardiac cycle, which modifies chest pressure and enhances the heart's ability to fill and empty effectively. This stimulation improves blood flow without placing additional stress on the heart muscle, making it a valuable intervention for patients with compromised cardiac function.

The device itself consists of two bipolar active fixation leads that are implanted on the underside of the diaphragm, along with a pulse generator and programming software. The laparoscopic approach utilized for this procedure involves making two small incisions, each approximately half an inch in length, through which the bipolar leads are implanted. Additionally, a small subcutaneous pocket is created in the abdominal area to accommodate the pulse generator, which is responsible for detecting cardiac activity. Once the leads are connected to the generator, the system sends a small electrical impulse to stimulate a specific area of the diaphragm, ensuring that normal breathing is not affected.

In cases where the existing diaphragmatic lead requires repositioning due to issues such as movement, malpositioning, infection, hematoma, or discomfort, CPT® Code 0677T should be reported. This repositioning procedure involves evaluating the lead's position and making necessary adjustments. If the lead is found to be malpositioned, it is carefully manipulated back into the correct position against the diaphragm. Any hematoma is evacuated, and if an infection is present, the area may be treated with an antibiotic solution. For each additional repositioned lead, CPT® Code 0678T is applicable, while CPT® Code 0679T is specifically used when the diaphragmatic lead(s) is completely removed.

1. Indications

The laparoscopic removal of diaphragmatic lead(s) using CPT® Code 0679T is indicated for patients who have a permanent implantable synchronized diaphragmatic stimulation (SDS) system that requires lead removal. This procedure is typically performed in cases where the leads may be causing complications or are no longer functioning as intended. The specific indications for this procedure include:

Moderate to Severe Heart Failure: Patients with moderate to severe heart failure who have a preserved ventricular synchrony may require the removal of the diaphragmatic lead(s) if complications arise.
Lead Malpositioning: If the existing diaphragmatic lead has become malpositioned, leading to ineffective stimulation or discomfort, removal may be necessary.
Infection: The presence of infection at the lead site may necessitate the removal of the lead(s) to prevent further complications.
Hematoma: If a hematoma develops around the lead, it may require removal to alleviate pressure and restore proper function.
Pain and Discomfort: Patients experiencing significant pain or discomfort at the lead site may need the lead(s) removed to improve their quality of life.

2. Procedure

The laparoscopic removal of diaphragmatic lead(s) involves several key procedural steps that ensure the safe and effective extraction of the leads. The procedure is performed under general anesthesia, and the following steps are typically followed:

Step 1: Preparation and Anesthesia: The patient is positioned appropriately, and general anesthesia is administered to ensure comfort and immobility during the procedure.
Step 2: Incision Creation: Two small incisions, each approximately half an inch in length, are made in the abdominal wall to allow access to the diaphragm. These incisions are strategically placed to minimize tissue damage and facilitate the laparoscopic approach.
Step 3: Lead Identification: A laparoscope is inserted through one of the incisions to visualize the diaphragm and the implanted leads. The surgeon carefully identifies the location of the diaphragmatic lead(s) that need to be removed.
Step 4: Lead Removal: The bipolar leads are gently detached from their fixation points on the diaphragm. The surgeon ensures that the leads are removed without causing damage to surrounding tissues.
Step 5: Pocket Closure: If a subcutaneous pocket was created for the pulse generator, it is assessed for any signs of infection or complications. The area is cleaned, and any necessary interventions are performed before closing the pocket.
Step 6: Incision Closure: Once the leads have been successfully removed and the area is clear of complications, the incisions are closed using sutures or surgical adhesive, and the laparoscope is removed.

3. Post-Procedure

After the laparoscopic removal of diaphragmatic lead(s), patients are typically monitored in a recovery area until the effects of anesthesia wear off. Post-procedure care may include pain management, monitoring for signs of infection, and ensuring that the surgical site is healing properly. Patients are usually advised to avoid strenuous activities for a specified period to allow for proper recovery. Follow-up appointments may be scheduled to assess the surgical site and discuss any further treatment options if necessary. It is important for patients to report any unusual symptoms, such as increased pain, swelling, or fever, to their healthcare provider promptly.

Short Descr	LAPS RMVL LEAD ISDSS
Medium Descr	LAPAROSCOPIC REMOVAL LEAD PERM ISDSS
Long Descr	Laparoscopic removal of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function
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	Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
Berenson-Eggers TOS (BETOS)	none
MUE	1