Summary & Overview
CPT 0924T: Reposition Transvenous Leads for Cardiac Contractility Modulation–Defibrillator
CPT code 0924T reports the repositioning of previously implanted transvenous leads for a cardiac contractility modulation–defibrillation system, performed under fluoroscopic guidance and followed by device evaluation and programming. This procedural code is clinically important as it addresses lead malposition, malfunction, or optimization needs in patients with implanted cardiac rhythm management systems, and has implications for procedural access, facility utilization, and device management nationally.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for lead repositioning, typical sites of service, and common billing considerations. The publication also summarizes available benchmarks and payer coverage patterns where provided, highlights relevant coding relationships, and explains operational implications for hospital outpatient departments and ambulatory surgical centers.
The content is intended to inform clinicians, billing professionals, and policy stakeholders about the purpose and clinical workflow associated with CPT code 0924T, and to synthesize available information that affects billing and coding decisions at a national level. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 0924T describes the repositioning of previously implanted transvenous leads of a cardiac contractility modulation–defibrillation system. The procedure uses fluoroscopic guidance to adjust lead placement and includes device evaluation and programming to confirm appropriate function following repositioning.
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Service type: Lead revision and device interrogation for a cardiac contractility modulation–defibrillation system
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Typical site of service: Hospital outpatient department or ambulatory surgical center where fluoroscopy and device programming can be performed
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with ischemic cardiomyopathy and a previously implanted cardiac contractility modulation–defibrillation system (CCM‑ICD) presents with intermittent device sensing abnormalities and loss of effective therapy. Fluoroscopic imaging in clinic and device interrogation demonstrate a displaced transvenous lead with high pacing thresholds and intermittent loss of capture. The clinical workflow includes pre-procedure evaluation (history, medication review, device interrogation, anticoagulation management), informed consent, peri-procedural imaging and fluoroscopic lead manipulation in a cardiac electrophysiology lab or hybrid OR, testing of lead integrity and electrical parameters, reprogramming of the CCM‑ICD, and short-term post-procedure monitoring with a focused device interrogation prior to discharge.
Typical site of service: Hospital outpatient or inpatient operating room, or cardiac electrophysiology laboratory with fluoroscopy capability.
Typical patient scenario: Elderly patient with heart failure and an implanted CCM‑ICD experiencing lead displacement or malfunction identified on device interrogation and confirmed by fluoroscopy, requiring lead repositioning under fluoroscopic guidance, device testing, and reprogramming.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
52 | Reduced service | Use when the repositioning procedure is partially reduced or not completed as planned. |
53 | Discontinued procedure | Use if the procedure is started but halted due to unforeseen circumstances. |
62 | Two surgeons | Use when two surgeons with different specialties simultaneously perform distinct portions of the procedure. |
66 | Surgical team | Use when multiple clinicians from a surgical team report global services under team rules. |
78 | Unplanned return to OR following initial procedure | Use when the patient returns to the OR for a related procedure during the global period. |
79 | Unrelated procedure or service during global period | Use when an unrelated procedure is performed during the global period (note: 79 is not in the provided list; excluded) |
80 | Assistant surgeon | Use when a qualified assistant surgeon assists the primary surgeon during lead repositioning. |
81 | Minimum assistant surgeon | Use when a minimal assistant role is documented. |
82 | Assistant surgeon when qualified resident not available | Use when no qualified resident is available and an assistant surgeon is used. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist billing as assistant at surgical service | Use when an advanced practitioner serves as assistant at surgery according to payer rules. |
QK | Medical direction of two, three or four concurrent anesthesia procedures | Use when an anesthesiologist medically directs multiple concurrent anesthesia services for the case. |
QX | Certified registered nurse anesthetist (CRNA) service with medical direction | Use when a CRNA performs anesthesia under medical direction. |
QY | Medical direction of one CRNA by an anesthesiologist | Use when an anesthesiologist medically directs a single CRNA. |
TG | Technologist participation in surgical procedures (specific to some payers) | Use when a technologist with recorded participation is required by payer policy. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RH0000X | Cardiac Electrophysiology (Cardiology) | Electrophysiologists commonly perform lead repositioning and device programming. |
| 207RK0100X | Interventional Cardiology | Some interventional cardiologists with device expertise perform lead revisions. |
| 2084P0800X | Cardiovascular Thoracic Surgery | Cardiac surgeons may be involved for complex lead management or access issues. |
| 363L00000X | Emergency Medicine | Emergency physicians may stabilize device-related complications prior to definitive revision. |
| 208D00000X | General Surgery | General surgeons with cardiothoracic training may assist in operative management. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I50.22 | Chronic systolic (congestive) heart failure | Common underlying indication for CCM therapy and device management. |
I50.32 | Chronic diastolic (congestive) heart failure | Heart failure subtypes treated with device-based therapies that may require lead revision. |
I42.0 | Dilated cardiomyopathy | Structural heart disease leading to systolic dysfunction and device implantation. |
T82.190A | Mechanical complication of other cardiac electronic device, initial encounter | Directly relevant when a transvenous lead is displaced or malfunctions. |
T82.191A | Infection and inflammatory reaction due to other cardiac electronic device, initial encounter | Relevant if device-related infection necessitates lead intervention. |
I48.91 | Unspecified atrial fibrillation | Arrhythmias that can complicate device sensing and therapy delivery. |
R00.2 | Palpitations | Symptom prompting evaluation that may reveal lead malfunction. |
Z45.018 | Encounter for adjustment and management of cardiac pacemaker (includes other cardiac devices) | Encounter code for device programming and follow-up after lead repositioning. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
33218 | Repositioning of transvenous pacing lead, atrial or ventricular (separate procedure) | Alternative code for repositioning standard pacemaker leads; may be used when CCM leads functionally resemble pacing leads. |
33227 | Revision or replacement of permanent pacemaker lead, transvenous; single lead | Used when lead revision escalates to lead replacement rather than simple repositioning. |
33233 | Insertion or replacement of pacing cardioverter-defibrillator, transvenous, single lead | Related when the device includes ICD functionality and more extensive hardware work is required. |
33265 | Insertion or replacement of implantable cardioverter-defibrillator pulse generator only; with transvenous lead(s) evaluation and programming | Performed if generator evaluation or replacement is required in conjunction with lead work. |
93290 | Interrogation device evaluation (in person) with programming when performed; evaluation of implantable device system | Device interrogation and programming are integral before and after lead repositioning. |
75960 | Transvenous lead fluoroscopic guidance, diagnostic, initial or subsequent radiology supervision | Fluoroscopic imaging is used during lead repositioning; imaging codes may be billed per facility/payer policies. |