CPT® Code 0679T

Laparoscopic removal of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function

The procedure described by CPT® Code 0679T involves the laparoscopic removal of diaphragmatic lead(s) that are part of a permanent implantable synchronized diaphragmatic stimulation (SDS) system. This system is designed to augment cardiac function, particularly in patients suffering from moderate to severe heart failure while maintaining preserved ventricular synchrony. The SDS system works by stimulating the diaphragm in synchronization with the cardiac cycle, which modifies chest pressure and enhances the heart's ability to fill and empty effectively. This stimulation improves blood flow without placing additional stress on the heart muscle, making it a valuable intervention for patients with compromised cardiac function.

The device itself consists of two bipolar active fixation leads that are implanted on the underside of the diaphragm, along with a pulse generator and programming software. The laparoscopic approach utilized for this procedure involves making two small incisions, each approximately half an inch in length, through which the bipolar leads are implanted. Additionally, a small subcutaneous pocket is created in the abdominal area to accommodate the pulse generator, which is responsible for detecting cardiac activity. Once the leads are connected to the generator, the system sends a small electrical impulse to stimulate a specific area of the diaphragm, ensuring that normal breathing is not affected.

In cases where the existing diaphragmatic lead requires repositioning due to issues such as movement, malpositioning, infection, hematoma, or discomfort, CPT® Code 0677T should be reported. This repositioning procedure involves evaluating the lead's position and making necessary adjustments. If the lead is found to be malpositioned, it is carefully manipulated back into the correct position against the diaphragm. Any hematoma is evacuated, and if an infection is present, the area may be treated with an antibiotic solution. For each additional repositioned lead, CPT® Code 0678T is applicable, while CPT® Code 0679T is specifically used when the diaphragmatic lead(s) is completely removed.