Summary & Overview
CPT 0920T: Removal of Single Transvenous Pacing Lead from CCM-Defibrillator
CPT code 0920T denotes the surgical removal of a single transvenous pacing lead from a permanent cardiac contractility modulation–defibrillation system. As device-based heart-failure and rhythm-management therapies expand, precise coding for lead removal is important for clinical documentation, facility billing, and national utilization tracking. The code captures a specific extraction of a single lead from a combined CCM–defibrillator implant.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on the clinical context for lead extraction, the typical site of service, and common modifiers used with this service when available. The publication outlines national benchmarking themes, variation drivers, and recent policy and coding clarifications relevant to device lead management.
This summary equips clinicians, coding professionals, and policy analysts with the essential framing for 0920T: what the code represents, which payers are included in typical coverage comparisons, and the types of operational and policy topics addressed in the full publication. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
CPT code 0920T describes the removal of a single transvenous pacing lead from a permanent cardiac contractility modulation–defibrillation system. This procedure involves extraction of a pacing lead that was implanted transvenously as part of a combined device providing cardiac contractility modulation and defibrillation therapy.
-
Service type: Lead extraction procedure
-
Typical site of service: Hospital operating room or electrophysiology/cardiac catheterization laboratory
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with a previously implanted permanent cardiac contractility modulation–defibrillation (CCM‑ICD) system presents with recurrent device-related infection and lead malfunction localized to a single transvenous pacing lead. The patient is anticoagulated for atrial fibrillation and has ischemic cardiomyopathy with reduced ejection fraction. Pre-procedure evaluation includes device interrogation, chest radiography, transthoracic echocardiography to exclude large vegetations, INR check and perioperative anticoagulation planning, and informed consent that documents risks of extraction (bleeding, vascular injury, need for open surgery). The extraction is scheduled in the cardiac electrophysiology lab or hybrid operating room with cardiothoracic surgery and anesthesia immediately available. The clinical workflow includes: pre-op device programming to disable tachyarrhythmia therapies, sterile preparation, fluoroscopic guidance, lead extraction using locking stylets or sheaths as indicated, hemostasis, post-extraction device interrogation, wound management, and overnight telemetry monitoring. The service is typically billed as a surgical endovascular procedure representing removal of a single transvenous pacing lead of a permanent CCM‑defibrillation system.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required to remove the lead is substantially greater than typical due to complexity (extensive adhesions, prolonged extraction time) and documentation supports increased work. |
23 | Unusual anesthesia | Use when medically necessary anesthesia is provided for an otherwise normally non-anesthetized procedure (e.g., general anesthesia required for complex extraction). |
51 | Multiple procedures | Use when multiple distinct procedures are performed and payer requires reporting of multiple procedure modifier. |
52 | Reduced services | Use when the extraction is partially completed or intentionally reduced (e.g., attempt aborted with partial removal). |
53 | Discontinued procedure | Use when the procedure is terminated due to extenuating circumstances after initiation (e.g., conversion to open surgery). |
62 | Two surgeons | Use when two surgeons with different NPI numbers of equal specialty participate throughout the procedure. |
78 | Unplanned return to OR | Use for a related procedure resulting from a complication requiring return to the operating room within the global period. |
80 | Assistant surgeon | Use when an assistant surgeon performs part of the extraction and payer requires reporting of assistant services. |
66 | Surgical team (high complexity) | Use when a documented surgical team approach is billed by separate surgeons meeting payer criteria. |
AS | Physician assistant, nurse practitioner, clinical nurse specialist services for assistant at surgery | Use when an advanced practice clinician serves as the surgical assistant and payer recognizes AS. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RH0000X | Cardiac Electrophysiology | Electrophysiologists commonly perform transvenous lead extraction and device management. |
| 207RC0000X | Interventional Cardiology | Interventional cardiologists experienced in device extractions in hybrid OR settings. |
| 2080P0015X | Cardiothoracic Surgery | Cardiothoracic surgeons provide backup for surgical conversion and complex extractions. |
| 363L00000X | Vascular Surgery | Vascular surgeons consulted for complex venous injury or hybrid access management. |
| 208200000X | General Cardiology | Heart failure and device clinics coordinate pre- and post-procedure care. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I50.22 | Chronic systolic (congestive) heart failure | Common indication for CCM therapy; heart failure may necessitate device removal for infection or malfunction. |
T82.7XXA | Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter | Directly relevant when device- or lead-related infection prompts extraction. |
T82.89XA | Other complications of cardiac and vascular devices, implants and grafts, initial encounter | Used for noninfectious complications such as lead fracture or insulation failure leading to removal. |
I48.91 | Unspecified atrial fibrillation | A common comorbidity influencing anticoagulation management during extraction. |
Z45.2 | Encounter for adjustment and management of cardiac device | Relevant for pre- and post-procedure device interrogation, programming, and follow-up care. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
33210 | Removal of permanent pacemaker pulse generator; with replacement of same pulse generator, same pulse generator pocket | May be performed if generator exchange is required at time of lead removal or when device replacement is planned. |
33212 | Removal of permanent pacemaker pulse generator; with insertion of new pulse generator, different pulse generator pocket, or other complex generator procedure | Related when generator repositioning or more complex generator work accompanies lead extraction. |
33234 | Removal of pacing lead(s) (by traction and/or without operative exposure of the generator pocket) | Related for removal of non-ICD pacing leads by simple traction techniques; contrast with 0920T which specifies a CCM‑defibrillation system lead. |
33244 | Removal of transvenous electrode(s), single lead, with open surgical exposure of generator pocket | Used when extraction requires open surgical exposure of the generator pocket as part of removal. |
33262 | Removal of single transvenous pacing lead, open approach | Represents an open surgical removal code used when endovascular techniques are not feasible and conversion to open surgery occurs. |