CPT® Code 71090

Deleted

1. Indications

The procedure associated with CPT® Code 71090 is indicated for patients who require the implantation of a pacemaker due to various cardiac conditions. These conditions may include, but are not limited to, the following:

• Bradycardia - A condition characterized by an abnormally slow heart rate, which may necessitate the use of a pacemaker to maintain adequate heart function.
• Heart Block - A situation where the electrical signals in the heart are delayed or blocked, leading to ineffective heartbeats that can be corrected with a pacemaker.
• Cardiac Arrhythmias - Irregular heartbeats that can cause symptoms such as dizziness, fatigue, or fainting, which may require pacing for stabilization.
• Post-Myocardial Infarction - Following a heart attack, some patients may develop conduction abnormalities that necessitate pacemaker insertion.

2. Procedure

The procedure for pacemaker insertion, as described under CPT® Code 71090, involves several critical steps that ensure the successful placement of the device. Each step is performed with precision and under the guidance of radiological imaging.

• Step 1: Incision - The procedure begins with the surgeon making a small incision in the upper chest area, typically just below the collarbone. This incision provides access to the underlying tissues and blood vessels necessary for the insertion of the pacemaker.
• Step 2: Sheath Insertion - Following the incision, a sheath is carefully inserted into the selected blood vessel. This sheath serves as a conduit through which the pacemaker lead will be advanced into the heart.
• Step 3: Lead Advancement - Under continuous fluoroscopic and radiographic guidance, the pacemaker wire, or lead, is advanced through the sheath into the appropriate heart chamber. This step is critical as it ensures accurate placement of the lead for effective pacing.
• Step 4: Lead Positioning and Testing - Once the lead is in place, it is positioned against the heart wall. The lead's functionality is then tested to confirm that it is correctly sensing and pacing the heart as intended.
• Step 5: Connection to Pulse Generator - After successful testing, the lead is connected to a pulse generator. This generator is responsible for delivering electrical impulses to the heart to maintain a normal rhythm.
• Step 6: Final Testing - The pulse generator is also tested to ensure it is functioning properly and effectively communicating with the lead.
• Step 7: Generator Placement - Finally, the pulse generator is placed in a subcutaneous pocket created under the collarbone, completing the procedure.

3. Post-Procedure

After the pacemaker insertion procedure, patients typically require monitoring to assess the functionality of the device and to observe for any immediate complications. Post-procedure care may include instructions on activity restrictions, wound care, and follow-up appointments for device checks. Patients are often advised to avoid strenuous activities for a specified period to allow for proper healing. Additionally, they may need to be educated on recognizing signs of potential complications, such as infection or lead displacement, and when to seek medical attention. Regular follow-up visits are essential to ensure the pacemaker is functioning correctly and to make any necessary adjustments to the device settings.