CPT® Code 0823T

Official Description

Transcatheter insertion of permanent single-chamber leadless pacemaker, right atrial, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography and/or right ventriculography, femoral venography, cavography) and device evaluation (eg, interrogation or programming), when performed

Common Language Description

The procedure described by CPT® Code 0823T involves the transcatheter insertion of a permanent single-chamber leadless pacemaker into the right atrium of the heart. A leadless pacemaker is a compact device that functions as a pulse generator, equipped with an integrated battery and electrode, designed to regulate heart rhythms. This specific type of pacemaker is utilized primarily for atrial pacing, which is essential in treating conditions such as sick sinus syndrome or sinus node dysfunction that can lead to symptomatic bradycardia. Additionally, it plays a role in reducing the frequency of paroxysmal atrial fibrillation, a condition characterized by intermittent episodes of rapid heart rate. Before the insertion of the pacemaker, surface electrocardiogram (EKG) electrodes or programming leads may be placed on the patient's chest to facilitate monitoring and programming of the device. The procedure begins with the preparation and draping of the groin area, followed by access to the femoral vein. A guidewire is then introduced, and venous ultrasound may be employed to visualize the anatomical structures, ensuring accurate placement of the device. The insertion process involves the placement of a femoral sheath, which is gradually dilated to accommodate the leadless pacemaker introducer. Once the introducer is in place, the guidewire is removed, and a steerable delivery catheter containing the preloaded leadless pacemaker is advanced through the inferior vena cava into the right atrium under fluoroscopic guidance. Contrast material may be injected to enhance visualization of the anatomy during this critical step. After confirming the correct positioning, the pacemaker's functionality is tested by sending signals from an external programming device. The device is then securely deployed against the endocardium, and various tests, including pacing capture threshold, impedance, and sensing amplitude, are conducted to ensure optimal performance. The tethering of the pacemaker allows for any necessary repositioning and retesting before the final release of the tether and withdrawal of the delivery catheter, completing the procedure.

1. Indications

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

Sick Sinus Syndrome - A condition where the heart's natural pacemaker (the sinus node) does not function properly, leading to irregular heart rhythms.
Sinus Node Dysfunction with Symptomatic Bradycardia - A situation where the heart beats too slowly, causing symptoms such as fatigue, dizziness, or fainting.
Paroxysmal Atrial Fibrillation - A type of irregular heartbeat that occurs intermittently, which can lead to complications if not managed properly.

2. Procedure

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

Preparation - The patient is positioned appropriately, and surface EKG electrodes or programming leads are placed on the chest to monitor heart activity during the procedure. The groin area is then prepped and draped to maintain a sterile environment.
Accessing the Femoral Vein - A puncture is made in the femoral vein, and a guidewire is introduced to facilitate the insertion of the necessary sheaths and catheters.
Venous Ultrasound - This imaging technique may be utilized to visualize the anatomy of the venous structures, ensuring accurate access and placement of the devices.
Placement of Femoral Sheath - A femoral sheath is inserted into the vein, and dilation is performed incrementally to accommodate the introducer for the leadless pacemaker.
Introducer Placement - The leadless pacemaker introducer is placed through the femoral sheath, and the guidewire is subsequently removed to prepare for the delivery of the pacemaker.
Advancing the Delivery Catheter - Under fluoroscopic guidance, a steerable delivery catheter containing the preloaded leadless pacemaker is threaded through the introducer and advanced through the inferior vena cava into the right atrium.
Contrast Injection - Contrast material may be injected to enhance visualization of the anatomical structures during the advancement of the catheter and pacemaker.
Testing Pacemaker Function - The pacemaker's functionality is tested by sending signals from an external programming device to ensure it is operating correctly.
Mapping and Deployment - Mapping is performed to ensure accurate placement of the pacemaker, which is then deployed and positioned securely against the endocardium.
Final Testing and Tether Release - The pacemaker is undocked but left tethered while pacing capture threshold, impedance, and sensing amplitude tests are conducted. Any necessary repositioning and retesting are performed before the tether is released, and the delivery catheter is withdrawn.

3. Post-Procedure

After the transcatheter insertion of the leadless pacemaker, the patient is monitored for any immediate complications or adverse reactions. Standard post-procedure care includes monitoring vital signs and ensuring the pacemaker is functioning correctly. Patients may be advised on activity restrictions and follow-up appointments for device interrogation and programming adjustments. It is essential to assess the pacemaker's performance and make any necessary modifications to optimize its function. Additionally, patients should be educated on signs of potential complications, such as infection or device malfunction, and instructed to seek medical attention if they experience any concerning symptoms.

Short Descr	TCAT INS 1CHMBR LDLS PM RA
Medium Descr	TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL
Long Descr	Transcatheter insertion of permanent single-chamber leadless pacemaker, right atrial, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography and/or right ventriculography, femoral venography, cavography) and device evaluation (eg, interrogation or programming), when performed
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