CPT® Code 0797T

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 ventricular pacemaker component (when part of a dual-chamber leadless pacemaker system)

Common Language Description

The procedure described by CPT® Code 0797T involves the transcatheter insertion of a permanent dual-chamber leadless pacemaker, which is a sophisticated medical 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. This specific procedure is indicated for patients suffering from conditions such as sinus node dysfunction, where the heart's natural pacemaker fails to function properly, and atrioventricular (AV) block, which disrupts the electrical signals between the heart's chambers. The dual-chamber system allows for more precise pacing of both the atrium and ventricle, enhancing the heart's ability to pump blood effectively. In certain clinical scenarios, the ventricular component of the dual-chamber leadless pacemaker may be inserted independently. This can occur when a dual system is being placed in stages or when an existing ventricular component has malfunctioned, making it safer to introduce a new leadless pacemaker without removing the old one. Prior to the insertion, surface EKG electrodes or programming leads may be applied to the patient's chest to facilitate monitoring and programming of the device. The procedure requires careful imaging guidance, which may include fluoroscopy, venous ultrasound, and various angiographic techniques to ensure accurate placement of the pacemaker within the heart. Overall, this advanced procedure represents a significant innovation in cardiac pacing technology, providing a less invasive option for patients requiring heart rhythm management.

1. Indications

The transcatheter insertion of a permanent dual-chamber leadless pacemaker is indicated for the following conditions:

Sinus Node Dysfunction - A condition where the heart's natural pacemaker fails to generate adequate electrical impulses, leading to bradycardia or irregular heart rhythms.
Atrioventricular (AV) Block - A disorder that disrupts the conduction of electrical signals between the atria and ventricles, potentially resulting in a slow heart rate or complete heart block.

2. Procedure

The procedure for the transcatheter insertion of a permanent dual-chamber leadless pacemaker involves several critical steps to ensure successful implantation and functionality of the device.

Preparation - The patient is positioned appropriately, and surface EKG electrodes or programming leads are placed on the chest to monitor heart activity and facilitate device programming. The groin area is then prepped and draped to maintain a sterile environment.
Accessing the Femoral Vein - A puncture is made to access the femoral vein, and a guidewire is introduced to facilitate the placement of a femoral sheath. Venous ultrasound may be utilized to visualize the anatomy and ensure proper access.
Sheath Placement and Dilation - A femoral sheath is inserted, and the vein is dilated incrementally to accommodate the delivery system for the leadless pacemaker.
Introducer Placement - The leadless pacemaker introducer is placed, and the guidewire is removed, allowing for the next steps in the procedure.
Catheter Advancement - Under fluoroscopic guidance, the first steerable delivery catheter, which contains an integrated guide catheter and the preloaded leadless pacemaker, is threaded through the introducer and advanced into the right ventricle.
Device Testing - The pacemaker is tested by sending signals from an external programmer to ensure it is functioning correctly. Mapping is performed to determine the optimal placement within the heart.
Deployment - The leadless pacemaker is deployed and positioned securely against the endocardium, ensuring stable contact for effective pacing.
Testing and Confirmation - The pacemaker is undocked but remains tethered. Pacing capture threshold, impedance, and sensing tests are conducted to confirm the adequacy of the implantation site. Any necessary repositioning and retesting are performed to ensure optimal placement.
Finalization - Once confirmed, the tether is released, and the delivery catheter is withdrawn. The ventricular pacemaker is paired to communicate with the existing atrial pacemaker, ensuring synchronized pacing. Finally, all instruments are removed, and the access site is closed.

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 ventricular and atrial components. It is essential to provide the patient with instructions regarding activity restrictions and signs of potential complications that should prompt immediate medical attention. Regular follow-up appointments will be necessary to evaluate the pacemaker's performance and make any required adjustments.

Short Descr	TCAT INS 2CHMBR LDLS PM RV
Medium Descr	TCAT INSJ PERM 2CHMBR LDLS PM R VENTR 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 ventricular pacemaker component (when part of 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
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

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