CPT® Code 0696T

1. Indications

The procedure coded as CPT® 0696T is indicated for patients who have undergone cardiac resynchronization therapy (CRT) and require optimization of their pacing device. The following conditions or symptoms may warrant the use of body surface-activation mapping:

• Electrical Dyssynchrony - Patients exhibiting signs of electrical dyssynchrony, which can lead to inefficient heart function and symptoms such as fatigue, shortness of breath, or exercise intolerance.
• Follow-Up Evaluation - Patients who are due for follow-up interrogation of their CRT device to assess its performance and make necessary programming adjustments.
• Device Optimization - Individuals needing individualized programming of their CRT device to enhance cardiac output and improve overall heart function.

2. Procedure

The procedure for body surface-activation mapping (CPT® 0696T) involves several key steps to ensure accurate assessment and optimization of the cardiac resynchronization therapy device:

• Preparation - The patient is prepared for the procedure by ensuring that the skin on the chest and back is clean and free of any obstructions that may interfere with electrode placement. A conducting gel is applied to enhance the electrical connection between the electrodes and the skin.
• Electrode Placement - A vest containing 64 to 120 electrodes is fitted onto the patient. The electrodes are strategically positioned to cover a large area of the torso, allowing for comprehensive mapping of the heart's electrical activity.
• Data Collection - Once the electrodes are in place, the mapping system records the electrocardiac activity. This data collection phase captures the QRS, ST, and T waveforms, which are essential for analyzing the heart's electrical synchronization.
• Data Review - After data collection, the recorded information is reviewed to assess the distribution of electrical potentials across the body surface. This review is critical for identifying areas of electrical dyssynchrony.
• Analysis and Reporting - The activation times are calculated, and parameters such as the standard deviation of activation times (SDAT) and the average left thorax activation time (LVAT) are derived. These metrics are used to evaluate the effectiveness of the current pacing settings and to guide adjustments for optimal device performance.
• Disconnection - Following the analysis, the electrodes are carefully disconnected from the patient, and the vest is removed. The data collected is then compiled into a report that summarizes the findings and recommendations for device programming.

3. Post-Procedure

After the body surface-activation mapping procedure, patients may be monitored for any immediate reactions or complications. The results of the mapping will inform the physician on necessary adjustments to the CRT device settings to enhance cardiac function. Patients are typically advised on follow-up appointments to reassess the device's performance and to ensure that the programming adjustments have effectively improved their symptoms. It is essential for healthcare providers to document the findings and any changes made to the device settings in the patient's medical record for future reference and continuity of care.