CPT® Code 0410T

Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; atrial electrode only

A permanent cardiac contractility modulation (CCM) system is a specialized medical device designed for patients suffering from moderate to severe chronic heart failure. This system operates by generating electrical impulses that are delivered during the absolute refractory period of the cardiac cycle. The primary purpose of these impulses is to enhance the contractility of the heart muscle, thereby improving its ability to pump blood effectively. Importantly, these impulses are non-excitatory, meaning they modulate the strength of the heart's contractions without altering the heart's rhythm. The procedure for inserting or replacing a CCM system involves making a small incision in the right pectoral region to create a pocket for the pulse generator. Access to the heart is achieved by identifying and accessing the right subclavian, cephalic, or axillary vein using a plastic sheath. Through this sheath, electrodes, also known as pacemaker lead wires, are inserted and guided under fluoroscopy to the heart. The sensing lead is strategically positioned in the right atrium, while two CCM transmission leads are placed in the upper and middle regions of the right ventricular septum. After connecting the leads to the pulse generator, the placement and functionality of the leads and generator are tested. If indicated, a contractility evaluation may be performed, and the pulse generator is programmed to establish the appropriate sensing and therapeutic parameters. Finally, the pulse generator is securely placed in the previously created pocket, and the incision is closed with sutures. This procedure is critical for patients who require enhanced cardiac function due to their heart failure condition.