CPT® Code 0677T

Laparoscopic repositioning of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, including connection to an existing pulse generator; first repositioned lead

A laparoscopic repositioning of diaphragmatic lead(s) involves the surgical adjustment of a permanent implantable synchronized diaphragmatic stimulation (SDS) system, which is designed to enhance cardiac function. This procedure is particularly relevant for patients suffering from moderate to severe heart failure, where the heart's ability to pump blood is compromised, yet ventricular synchrony is preserved. The SDS system works by stimulating the diaphragm in coordination with the heart's rhythm, which helps to modify chest pressure. This modification facilitates improved filling and emptying of the heart, ultimately enhancing blood flow without placing additional stress on the heart muscle itself. The system comprises two bipolar active fixation leads that are implanted on the underside of the diaphragm, a pulse generator that detects cardiac activity, and programming software to manage the device's functions. The laparoscopic approach utilized in this procedure involves making two small incisions, approximately half an inch in length, through which the leads are implanted. Additionally, a subcutaneous pocket is created in the abdomen to accommodate the pulse generator. The repositioning of the lead may be necessary due to various factors such as movement, malpositioning, infection, hematoma, or discomfort at the original site. The procedure ensures that the lead is correctly positioned against the diaphragm, and if any complications such as hematoma or infection are present, appropriate measures are taken to address them. This minimally invasive technique allows for effective management of the SDS system, contributing to improved cardiac function in patients with heart failure.