CPT® Code 0796T

Transcatheter insertion of permanent dual-chamber leadless pacemaker, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography, right ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed; right atrial pacemaker component (when an existing right ventricular single leadless pacemaker exists to create a dual-chamber leadless pacemaker system)

The procedure described by CPT® Code 0796T involves the transcatheter insertion of a permanent dual-chamber leadless pacemaker, which is a sophisticated device designed to regulate heart rhythms. A leadless pacemaker is a compact pulse generator that contains an integrated battery and electrode, eliminating the need for traditional leads that connect the pacemaker to the heart. In this specific procedure, the right atrial component of the dual-chamber system is inserted when there is already an existing right ventricular single leadless pacemaker in place. This upgrade is typically performed to address symptoms associated with sinus node dysfunction or pacemaker syndrome, which can occur when the heart's natural pacing system is compromised. The insertion process is guided by various imaging techniques, such as fluoroscopy, venous ultrasound, right atrial angiography, right ventriculography, and femoral venography, ensuring precise placement of the pacemaker. Prior to the procedure, surface EKG electrodes or programming leads may be applied to the patient's chest to facilitate communication with an external programming device. The procedure begins with the preparation and draping of the groin area, followed by access to the femoral vein. A guidewire is introduced, and venous ultrasound may be utilized to visualize the anatomy for safe navigation. Once the femoral sheath is placed and dilation is performed, the leadless pacemaker introducer is inserted, and the guidewire is removed. Under fluoroscopic guidance, a steerable delivery catheter containing the preloaded leadless pacemaker is advanced through the inferior vena cava into the right atrium. The pacemaker is then tested for functionality, and careful mapping is conducted to ensure accurate placement against the endocardium. After deployment, the pacemaker is undocked but remains tethered, allowing for pacing capture threshold, impedance, and sensing tests to confirm the adequacy of the implantation site. Any necessary repositioning and retesting are performed before the tether is released, and the delivery catheter is withdrawn. Finally, the atrial pacemaker is paired with the existing ventricular pacemaker, completing the dual-chamber system before the instruments are removed and the access site is closed.