Summary & Overview
CPT 0922T: Removal of Dual Transvenous Leads for CCM-Defibrillation System
CPT code 0922T denotes removal of dual transvenous leads — one pacing lead and one defibrillation lead — from a permanent cardiac contractility modulation–defibrillation system. As a specialized cardiac device extraction procedure, it is clinically significant for management of device-related complications, infections, lead malfunction, or system upgrades. Nationally, procedures involving complex lead extraction are high-cost, resource-intensive, and concentrated in facilities with electrophysiology and cardiac surgery capabilities.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of billing and coverage benchmarks for this code, typical sites of service and clinical context for when extraction is performed, and common payer considerations affecting authorization and payment. The summary highlights common modifiers and administrative notes where available, and flags areas where input data is not available.
The publication provides practical reference material for coding and billing staff, revenue cycle teams, and clinical program managers seeking concise context on use of 0922T. It summarizes what the code represents, who the major payers are, and what operational and clinical themes affect documentation and reimbursement for dual transvenous lead removal of a cardiac contractility modulation–defibrillation system.
Billing Code Overview
CPT code 0922T describes removal of dual transvenous leads — one lead for cardiac pacing and one lead for defibrillation — from a permanent cardiac contractility modulation–defibrillation system. The procedure involves extraction of both transvenous leads that comprise the implantable device system.
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Service type: Lead extraction procedure for a cardiac contractility modulation–defibrillation system
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Typical site of service: Inpatient or outpatient hospital setting or cardiac electrophysiology laboratory where device extractions and complex cardiac device procedures are performed
Clinical & Coding Specifications
Clinical Context
A typical patient is a 60–75-year-old with an implanted permanent cardiac contractility modulation–defibrillation (CCM‑DF) system who presents for elective removal of dual transvenous leads (one pacing lead and one defibrillation lead). Indications for lead extraction include system infection (pocket infection, bacteremia, endocarditis), lead malfunction (insulation breach, conductor fracture, noise or failure to conduct therapy), or system upgrade/revision. The pre-procedure workflow includes device interrogation, chest radiography to define lead position and age, laboratory tests (complete blood count, coagulation profile), and informed consent documenting risks of extraction (tamponade, vascular injury, embolism). The procedure is performed in a cardiac catheterization laboratory or hybrid operating room with cardiothoracic surgical backup and general anesthesia or monitored anesthesia care. Fluoroscopic guidance is used for traction and advanced extraction tools (locking stylets, telescoping sheaths, powered sheaths) as needed. Intra-procedure monitoring includes continuous ECG, arterial line for hemodynamics in high-risk patients, and transesophageal or intracardiac echocardiography when available. After extraction, the patient is observed in a monitored setting; cultures and device pocket tissue are sent if infection was present. Documentation includes pre- and post‑procedure device status, extraction technique, tools used, estimated blood loss, complications, and final disposition.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or technical difficulty substantially exceeds usual for lead extraction and supported by operative report. |
23 | Unusual anesthesia | Use when medically necessary anesthesia is provided for a procedure that normally uses local anesthesia. |
51 | Multiple procedures | Use when multiple distinct CPT procedures are reported on the same date and payer allows. |
52 | Reduced services | Use when the procedure is partially reduced or not completed as originally planned. |
53 | Discontinued procedure | Use when the procedure is started but halted due to unforeseen circumstances. |
62 | Two surgeons | Use when two surgeons from different specialties work together as primary surgeons. |
66 | Surgical team | Use when a surgical team approach is documented for complex extraction. |
78 | Unplanned return to OR | Use when patient returns to the operating room for a related procedure during the postoperative period. |
80 | Assistant surgeon | Use when an assistant surgeon provides documented assistance and payer accepts this modifier. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Use when an advanced practice provider performed assistant-at-surgery duties and payer requires this modifier. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RC0000X | Cardiac Electrophysiology | Electrophysiologists commonly perform lead extraction procedures. |
| 207RC0200X | Clinical Cardiac Electrophysiology | Subspecialists focused on device management and extractions. |
| 207L00000X | Cardiovascular Disease (Cardiology) | Interventional cardiologists perform extractions in some centers. |
| 362500000X | Cardiovascular Thoracic Surgery | Cardiothoracic surgeons provide surgical backup and manage complications. |
| 390200000X | Anesthesiology | Anesthesiologists provide general anesthesia and advanced monitoring for complex extractions. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I46.9 | Cardiac arrest, cause unspecified | Extraction may be performed after device malfunction related to defibrillation failure in cardiac arrest scenarios. |
I49.01 | Ventricular fibrillation | Indication for ICD therapy; presence of defibrillation lead may necessitate extraction for malfunction or infection. |
I50.22 | Chronic systolic (congestive) heart failure | Patients with systolic heart failure may have CCM‑DF therapy; lead removal occurs for infection, malfunction, or system revision. |
T82.7XXA | Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter | Device or pocket infection is a common indication for complete system extraction. |
T82.221A | Displacement of transvenous cardiac pacemaker lead, initial encounter | Lead dislodgement or displacement can require lead removal and revision. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
33227 | Removal of permanent pacemaker lead(s) via transvenous extraction, single lead | May be billed for extraction of a single pacing lead when CCM‑DF system components are removed separately. |
33228 | Removal of permanent pacemaker lead(s) via transvenous extraction, each additional lead (list separately in addition to code for primary lead) | Used when more than one lead is extracted and payers require per‑lead reporting. |
33262 | Revision or removal of implantable receiver/ pulse generator without replacement | Billed when the implantable generator or CCM module is removed without immediate replacement. |
33233 | Removal/implantation procedures for implantable cardioverter‑defibrillator (ICD) leads — removal of single lead, transvenous | Used when defibrillation lead removal is reported under ICD‑specific extraction codes in some workflows. |
92980 | Transvenous lead placement, replacement, and/or repositioning additional procedure | May be reported if lead replacement or new system implantation is performed during the same encounter. |