CPT® Code 0796T

Official Description

Transcatheter insertion of permanent dual-chamber leadless pacemaker, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography, right ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed; right atrial pacemaker component (when an existing right ventricular single leadless pacemaker exists to create a dual-chamber leadless pacemaker system)

Common Language Description

The procedure described by CPT® Code 0796T involves the transcatheter insertion of a permanent dual-chamber leadless pacemaker, which is a sophisticated device designed to regulate heart rhythms. A leadless pacemaker is a compact pulse generator that contains an integrated battery and electrode, eliminating the need for traditional leads that connect the pacemaker to the heart. In this specific procedure, the right atrial component of the dual-chamber system is inserted when there is already an existing right ventricular single leadless pacemaker in place. This upgrade is typically performed to address symptoms associated with sinus node dysfunction or pacemaker syndrome, which can occur when the heart's natural pacing system is compromised. The insertion process is guided by various imaging techniques, such as fluoroscopy, venous ultrasound, right atrial angiography, right ventriculography, and femoral venography, ensuring precise placement of the pacemaker. Prior to the procedure, surface EKG electrodes or programming leads may be applied to the patient's chest to facilitate communication with an external programming device. The procedure begins with the preparation and draping of the groin area, followed by access to the femoral vein. A guidewire is introduced, and venous ultrasound may be utilized to visualize the anatomy for safe navigation. Once the femoral sheath is placed and dilation is performed, the leadless pacemaker introducer is inserted, and the guidewire is removed. Under fluoroscopic guidance, a steerable delivery catheter containing the preloaded leadless pacemaker is advanced through the inferior vena cava into the right atrium. The pacemaker is then tested for functionality, and careful mapping is conducted to ensure accurate placement against the endocardium. After deployment, the pacemaker is undocked but remains tethered, allowing for pacing capture threshold, impedance, and sensing tests to confirm the adequacy of the implantation site. Any necessary repositioning and retesting are performed before the tether is released, and the delivery catheter is withdrawn. Finally, the atrial pacemaker is paired with the existing ventricular pacemaker, completing the dual-chamber system before the instruments are removed and the access site is closed.

1. Indications

The transcatheter insertion of a permanent dual-chamber leadless pacemaker is indicated for patients experiencing specific cardiac conditions. These include:

Sinus Node Dysfunction - A condition where the heart's natural pacemaker fails to function properly, leading to irregular heart rhythms.
Pacemaker Syndrome - Symptoms that may arise when a single-chamber pacemaker is insufficient to manage the heart's pacing needs, often resulting in inadequate heart function.
Upgrade from Single to Dual System - When a patient with an existing right ventricular single leadless pacemaker requires additional pacing support from the right atrial component to improve cardiac function.

2. Procedure

The procedure for the transcatheter insertion of a permanent dual-chamber leadless pacemaker involves several critical steps:

Preparation and Access - The patient is positioned, and the groin area is prepped and draped to maintain a sterile environment. Access to the femoral vein is achieved, allowing for the introduction of necessary instruments.
Guidewire Placement - A guidewire is inserted into the femoral vein to facilitate the subsequent placement of the femoral sheath, which is essential for the delivery of the pacemaker.
Venous Ultrasound - This imaging technique may be employed to visualize the anatomy of the venous system, ensuring safe navigation during the procedure.
Sheath Placement and Dilation - A femoral sheath is placed, and the vein is dilated incrementally to accommodate the delivery system for the leadless pacemaker.
Introducer Insertion - The leadless pacemaker introducer is placed, and the guidewire is removed, allowing for the advancement of the delivery catheter.
Catheter Advancement - Under fluoroscopic guidance, the steerable delivery catheter, which contains the preloaded leadless pacemaker, is threaded through the introducer and advanced through the inferior vena cava into the right atrium.
Device Testing - The pacemaker is tested by sending signals from an external programmer to ensure it is functioning correctly before final placement.
Mapping and Deployment - Mapping is performed to ensure accurate placement of the leadless pacemaker against the endocardium, after which the device is deployed and positioned securely.
Testing and Confirmation - Pacing capture threshold, impedance, and sensing tests are conducted to confirm the adequacy of the implantation site within the atrium. Any necessary repositioning and retesting are performed to ensure optimal placement.
Tether Release and Catheter Withdrawal - Once confirmed, the tether is released, and the delivery catheter is withdrawn from the body.
Device Pairing - The atrial pacemaker is paired with the existing ventricular pacemaker to establish a dual-chamber pacing system.
Closure - Finally, all instruments are removed, and the access site is closed to complete the procedure.

3. Post-Procedure

After the transcatheter insertion of the permanent dual-chamber leadless pacemaker, patients are typically monitored for any immediate complications. Post-procedure care may include observation for signs of bleeding or infection at the access site. Patients may also undergo follow-up evaluations to assess the functionality of the pacemaker and ensure proper communication between the atrial and ventricular components. It is essential to provide patients with instructions regarding activity restrictions and signs of potential complications that should prompt immediate medical attention. Regular follow-up appointments will be necessary to monitor the pacemaker's performance and make any necessary adjustments to the programming.

Short Descr	TCAT INS 2CHMBR LDLS PM RA
Medium Descr	TCAT INSJ PERM 2CHMBR LDLS PM R ATR PM COMPNT
Long Descr	Transcatheter insertion of permanent dual-chamber leadless pacemaker, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography, right ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed; right atrial pacemaker component (when an existing right ventricular single leadless pacemaker exists to create a dual-chamber leadless pacemaker system)
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)	2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met.
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
Berenson-Eggers TOS (BETOS)	none
MUE	1

This is a primary code that can be used with these additional add-on codes.

93662

Addon Code MPFS Status: Carrier Priced APC N PUB 100 CPT Assistant Article Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (List separately in addition to code for primary procedure)

GC	This service has been performed in part by a resident under the direction of a teaching physician
Q0	Investigational clinical service provided in a clinical research study that is in an approved clinical research study