Single chamber icd cpt code

  • Single chamber icd cpt code

      the authors concluded that the findings of this study supported the safety and effectiveness of the s-icd system for the treatment of life-threatening ventricular arrhythmias. however, it is unclear if icd therapy will improve survival in these patients. efficiencies and complications of dual chamber versus single chamber implantable cardioverter defibrillators in secondary sudden cardiac death prevention: a meta-analysis. these researchers examined if icds are effective in preventing scd in high-risk heart transplant recipients.  adult patients with a standard indication for an icd, who neither required pacing nor had documented pace-terminable vt, were included in this study.  clinical trials demonstrating the effectiveness of icds in prevention of scd have, however, all used some form of defibrillation testing. et al (2011) stated that clinical practice with regard to dft testing during icd implantation varies considerably, even among experienced implanting centers.  the authors concluded that future results from ongoing clinical studies will determine the s-icd system's long-term performance, and better define suitable patient profiles.  although these data are reassuring and comparable to tv-icd success rates, the overall number of treated episodes is incredibly small in comparison with the data on transvenous defibrillator therapies delivered outside the hospital, over the life of the device, that are available for analysis in tens of thousands of patients. the role for icds in this population is not well-established.  the authors concluded that the impact of dft testing on 5-year survival in icd patients, if it exists, is small.-10 codes not covered for indications listed in the cpb:Paroxysmal tachycardia [not covered for incessant ventricular tachycardia, or spontaneous, frequently recurring ventricular tachycardia that is reliably terminated with anti-tachycardia pacing]. this has limited enthusiasm for the placement of aeds in the home of high-risk patients and primarily limited the role of the aed in the home to high-risk patients who either refuse an icd or have a contraindication to icd placement. evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters). worldwide experience with a totally subcutaneous implantable defibrillator: early results from the effortless s-icd registry. number of well-designed studies have shown the effectiveness of the icd in high-risk patients who have already experienced a myocardial infarction (mi)., the american college of cardiology foundation/american heart association task force on practice guidelines on “the management of st-elevation myocardial infarction” (o’gara et al, 2013) mentioned icd therapy; but not subcutaneous icd.
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Single chamber icd implantation cpt code

  these investigators recruited patients aged older than 18 years receiving their first icd for standard indications at 85 hospitals in 18 countries worldwide.  these investigators evaluated the impact of dft testing of implanted icds on survival.   codes requiring a 7th character are represented by "+":Implantable cardioverter-defibrillators:Cpt codes covered if selection criteria are met:Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator. the subcutaneous implantable cardioverter defibrillator (s-icd) system obviates some of the mechanical complications associated with transvenous lead implantation (e.  a total of 9 s-icd were implanted in 9 patients; 8 tv-icd were implanted in 6 patients; 2 were redo procedures. given the large pool of patients with less severe lv dysfunction and a modest risk of scd, methods to identify those who might benefit from an icd are needed. of complications at the time of tv-icd range from 3 to 6 % of implants.  patients undergoing initial implantation of a boston scientific icd were randomly assigned (1:1) using a computer-generated sequence to have either dft (testing group) or not (no-testing group)." the subcutaneous implantable defibrillator (s-icd) system uses a lead that is implanted just under the skin along the bottom of the rib cage and breast bone. and todd (2013) described the early phase united kingdom (uk) clinical experience with the s-icd. cpt codes related to the cpb:Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement;.  the authors concluded that in real-world use in children and teenagers, s-icd may offer similar survival benefit to tv-cd, with a lower incidence of complications requiring reoperation.  the fda reported that 8 patients died during the study; however, experts (who were not involved with the study) could not definitively attribute the deaths to the s-icd system. diagnostic code (acute mi), and then matched to device-recorded data. they retrospectively analyzed the records of all orthotopic heart transplant patients who had icd implantation between january 1995 and december 2005 at 5 heart transplant centers. underlying allograft vasculopathy was present in 100 % (8 of 8) of patients who received appropriate icd therapy.  patients undergoing initial implantation of a boston scientific icd were randomly assigned (1:1) using a computer-generated sequence to have either dft (testing group) or not (no-testing group). Online dating in orlando fl,

HCPCS Device Category C-codes (321kb)

the s-icd system consists of: a titanium case containing a battery and electronic circuitry that provides defibrillation therapy and pacing at a rate of 50 beats per minute up to 30 seconds after a shock; a subcutaneous electrode which has a proximal and distal ring electrode on each side of a 3 inch (8 cm) defibrillation coil electrode; and accessories include an electrode insertion tool, programmer, telemetry wand, magnet, suture sleeve, torque wrench, and memory card. the authors concluded that for survivors of anterior-wall mi who were not candidates for icd, access to a home aed did not significantly improve overall survival, as compared with reliance on conventional resuscitation methods. however, it is unclear if icd therapy will improve survival in these patients. the s-icd system consists of: a titanium case containing a battery and electronic circuitry that provides defibrillation therapy and pacing at a rate of 50 beats per minute up to 30 seconds after a shock; a subcutaneous electrode which has a proximal and distal ring electrode on each side of a 3 inch (8 cm) defibrillation coil electrode; and accessories include an electrode insertion tool, programmer, telemetry wand, magnet, suture sleeve, torque wrench, and memory card.  they stated that in the absence of randomized trials, s-icd should be compared prospectively with tv-icd in large multi-center registries with comparable periods of follow-up. the main indications for icd implantation were severe allograft vasculopathy (n = 12), unexplained syncope (n = 9), history of cardiac arrest (n = 8), and severe left ventricular dysfunction (n = 7). et al (2009) compared the outcome of icd recipients who underwent dft testing with that of patients in whom no testing was performed. the icd is generally accepted as treatment for patients who have experienced an episode of vf not accompanied by an acute myocardial infarction or other transient or reversible causes (e.  furthermore, by using far-field electrograms better tachyarrhythmia discrimination when compared to tv-icds has been reported. the potential use of genetic screening for desmoglein 2 mutations is for identifying persons at increased risk of arvd/c who are candidates for prophylactic icd. underlying allograft vasculopathy was present in 100 % (8 of 8) of patients who received appropriate icd therapy..  these investigators concluded that icd insertion without testing was non-inferior to icd with testing.  a questionnaire was sent to all uk hospitals implanting s-icds. meets above-listed criteria for an icd and has a systemic infectious process or other temporary condition that precludes icd implantation; or.  they stated that in the absence of randomized trials, s-icd should be compared prospectively with tv-icd in large multi-center registries with comparable periods of follow-up.  a total of 291 subjects with ischemic dilated cardiomyopathy received transvenous icds between january 2000 and december 2004 in 5 italian cardiology centers were included in this study. et al (2011) stated that clinical practice with regard to dft testing during icd implantation varies considerably, even among experienced implanting centers. Beyonce and jay z dating timeline

Single Chamber and Dual Chamber Permanent Cardiac

  this is concerning, because the population enrolled in the subcutaneous icd study were 10 to 20 years younger than the standard transvenous icd recipient.  survival of a hypothetical cohort of patients was assessed according to 2 strategies-routine dft testing at time of icd implant versus no dft testing. the authors concluded that use of icds after heart transplantation may be appropriate in selected high-risk patients. ongoing and planned studies will better define the role of using non-invasive tests to select patients for icd therapy. given the large pool of patients with less severe lv dysfunction and a modest risk of scd, methods to identify those who might benefit from an icd are needed.  the fda reported that 8 patients died during the study; however, experts (who were not involved with the study) could not definitively attribute the deaths to the s-icd system. currently, there are no prospective studies of the use of desmoglein 2 genetic testing for selecting icd candidates. schlapfer and colleagues (2002) compared the long-term survival rates of patients with sustained ventricular tachyarrhythmia after mi who were treated according to the results of ep study either with amiodarone or an icd.  the age of the subcutaneous icd recipients indicates that they may be a more active and more prone to over-sensing owing to subcutaneous sensing challenges or t-wave double counting ….  the authors concluded that routine defibrillation testing at the time of icd implantation is generally well-tolerated, but does not improve shock efficacy or reduce arrhythmic death. they retrospectively analyzed the records of all orthotopic heart transplant patients who had icd implantation between january 1995 and december 2005 at 5 heart transplant centers. the fda noted that, because the s-icd system memory stores data from only the 22 most recent arrhythmia episodes, there may have been other detected episodes that could not be analyzed by investigators. these survivors have various therapeutic options such as anti-arrhythmic drugs, radiofrequency or surgical ablation of vt focus, or implantable cardioverter-defibrillators (icds)." the subcutaneous implantable defibrillator (s-icd) system uses a lead that is implanted just under the skin along the bottom of the rib cage and breast bone. bardy et al (2008) randomly assigned 7,001 patients with previous anterior-wall mi who were not candidates for an icd to receive 1 of 2 responses to sudden cardiac arrest occurring at home: either the control response (calling emergency medical services and performing cpr) or the use of an aed, followed by calling emergency medical services and performing cpr.  being an entirely subcutaneous system it avoids important peri-procedural and long-term complications associated with transvenous implantable cardioverter-defibrillator (tv-icd) systems as well as the need for fluoroscopy during implant surgery.-10 codes covered if selection criteria are met:Certain infectious and parasitic disease [systemic infectious process].

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cardioverter-defibrillators:Cpt codes covered if selection criteria are met:Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed.   in the best of all possible worlds, the subcutaneous icd will grow and evolve into a device whose design supports the growth of features and capabilities that can evolve with the patient’s condition. and todd (2013) described the early phase united kingdom (uk) clinical experience with the s-icd.  being an entirely subcutaneous system it avoids important peri-procedural and long-term complications associated with transvenous implantable cardioverter-defibrillator (tv-icd) systems as well as the need for fluoroscopy during implant surgery. bardy et al (2008) randomly assigned 7,001 patients with previous anterior-wall mi who were not candidates for an icd to receive 1 of 2 responses to sudden cardiac arrest occurring at home: either the control response (calling emergency medical services and performing cpr) or the use of an aed, followed by calling emergency medical services and performing cpr. currently, there are no prospective studies of the use of desmoglein 2 genetic testing for selecting icd candidates. meets above-listed criteria for an icd and is awaiting heart transplantation; or.  this is concerning, because the population enrolled in the subcutaneous icd study were 10 to 20 years younger than the standard transvenous icd recipient. they found that the long-term survival of patients with sustained ventricular tachyarrhythmias after mi, with depressed lv function, is significantly better with an icd than with amiodarone therapy, even when stratified according to the results of the ep study. efficiencies and complications of dual chamber versus single chamber implantable cardioverter defibrillators in secondary sudden cardiac death prevention: a meta-analysis.  the wcd medical order registry was searched for patients who were coded as having had a "recent mi with ejection fraction less than or equal to 35 %" or given an international classification of diseases, 9th revision 410.  they also measured an inhomogeneous, center-dependent dft testing behavior, which suggested the importance of defining a common guideline for icd implant testing. an accompanying editorial of the afore-mentioned study, saxon noted that “over the follow-up interval reported in this study, the subcutaneous icd terminated spontaneously occurring vt/vf in 6. endocarditis or device infection as an indication for subcutaneous defibrillator:Implantable cardioverter-defibrillator: insertion of the electrode into the central venous circulation and inside cardiac chambers can cause vascular obstruction, thrombosis, infection and cardiac perforation. the s-icd system was successful at converting all abnormal heart rhythms that it detected back to normal rhythms. et al (2013) compared the performance of s-icd and tv-icd systems in children and teenagers.  data on 2,082 consecutive patients implanted with a medtronic icd in 111 italian centers, over the period 2007 to 2010, were analyzed.

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for patients with nidcm, there was a reduction in the mortality hazard ratio for icd therapy compared to control but it was also not statistically significant (hazard ratio 0. testing of single or dual chamber pacing cardioverter-defibrillator pulse generator.  data on 2,082 consecutive patients implanted with a medtronic icd in 111 italian centers, over the period 2007 to 2010, were analyzed.  however, conventional transvenous icd (tv-icd) systems come with the inherent drawbacks of transvenous leads, including:Risks at the time of insertion -- cardiac perforation, pericardial effusion, cardiac tamponade, hemothorax, pneumothorax. multi-center autonomic defibrillator implantation trial ii (madit ii) was stopped early because of a 30 % reduction in mortality in patients randomized to receive an icd (coats, 2002). center for medicare and medicaid services (cms) determined that the evidence is adequate to conclude that an icd is reasonable and necessary for the following: (i) patients with ischemic dilated cardiomyopathy (idcm), documented prior mi, and a measured lvef of less than or equal to 35 %; (ii) patients with non-ischemic dilated cardiomyopathy (nidcm) greater than 9 months with a measured ef less than or equal to 35 %.  the subcutaneous icd does not encompass these features nearly as much as the transvenous device. codes covered if selection criteria are met:Cardioverter-defibrillator, other than single or dual chamber (implantable) [subcutaneous cardioverter-defibrillators]. endocarditis or device infection as an indication for subcutaneous defibrillator:Implantable cardioverter-defibrillator: insertion of the electrode into the central venous circulation and inside cardiac chambers can cause vascular obstruction, thrombosis, infection and cardiac perforation. without remote monitoring capability, it will be difficult to track the occurrences of these episodes in the population of patients who receive the subcutaneous icd. this has limited enthusiasm for the placement of aeds in the home of high-risk patients and primarily limited the role of the aed in the home to high-risk patients who either refuse an icd or have a contraindication to icd placement. the role for icds in this population is not well-established. codes not covered for indications listed in the cpb:External defibrillator with integrated electrocardiogram analysis. et al (2013) stated that the s-icd has recently been approved for commercial use in europe, new zealand and the united states. of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) (list separately in addition to code for primary procedure)., the american college of cardiology foundation/american heart association task force on practice guidelines on “the management of st-elevation myocardial infarction” (o’gara et al, 2013) mentioned icd therapy; but not subcutaneous icd. the main indications for icd implantation were severe allograft vasculopathy (n = 12), unexplained syncope (n = 9), history of cardiac arrest (n = 8), and severe left ventricular dysfunction (n = 7). Dating a stock transfer form

Cardioverter-Defibrillators

there is mounting evidence for the efficacy of icds in patients at increased risk for sudden cardiac death. these researchers examined if icds are effective in preventing scd in high-risk heart transplant recipients. threshold (dft) testing during implantable cardioverter-defibrillator implantation:Gula et al (2008) noted that defibrillation threshold (dft) testing is generally performed during implantation of icds to assess sensing and termination of vf.  nevertheless, given the absence of intra-cavitary leads, the s-icd is unable to offer pacing (apart from short-term post-shock pacing).  current data from initial clinical studies and post-commercialization "real-life" case series, including over 700 patients, have so far been promising and shown that the s-icd successfully converts induced and spontaneous vt/vf episodes with associated complication and inappropriate shock rates similar to that of tv-icds. or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber. or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing.  adult patients with a standard indication for an icd, who neither required pacing nor had documented pace-terminable vt, were included in this study. center for medicare and medicaid services expanded coverage of icds to persons with nidcm, based primarily on the results of the sudden cardiac death in heart failure trial (scd-heft), a prospective randomized trial to determine whether amiodarone or an icd will improve survival compared to placebo in patients with nyha class ii and class iii heart failure and reduced lvef less than 35 %. madit ii, the multi-center autonomic defibrillator implantation trial ii stopped early for mortality reduction, has icd therapy earned its evidence-based credentials?.  these investigators concluded that icd insertion without testing was non-inferior to icd with testing.  the primary safety end-point was the 180-day s-icd system complication-free rate compared with a pre-specified performance goal of 79 %. et al (2009) compared the outcome of icd recipients who underwent dft testing with that of patients in whom no testing was performed.  the wcd medical order registry was searched for patients who were coded as having had a "recent mi with ejection fraction less than or equal to 35 %" or given an international classification of diseases, 9th revision 410.  although the subcutaneous icd is de-featured and exists only to defibrillate, it does represent a major engineering feat for an entirely subcutaneous system. codes covered if selection criteria are met:Cardioverter-defibrillator, dual chamber (implantable). the s-icd system was successful at converting all abnormal heart rhythms that it detected back to normal rhythms.

Implantable Cardioverter Defibrillator,

Transmittal R3204CP

the subcutaneous implantable cardioverter defibrillator (s-icd) system obviates some of the mechanical complications associated with transvenous lead implantation (e. the fda reviewed safety data based on the entire 321-patient study population to identify complications that can occur during and after implantation of the s-icd system. the authors concluded that use of icds after heart transplantation may be appropriate in selected high-risk patients.  these researchers studied consecutive patients less than 20 years of age who received an icd over a 4-year period in 2 scottish centers. the fda approval was based upon the results of a 321-patient study in which 304 patients were successfully implanted with the s-icd system. the authors concluded that for survivors of anterior-wall mi who were not candidates for icd, access to a home aed did not significantly improve overall survival, as compared with reliance on conventional resuscitation methods.-10 codes covered if selection criteria are met:Certain infectious and parasitic disease [systemic infectious process].  a total of 291 subjects with ischemic dilated cardiomyopathy received transvenous icds between january 2000 and december 2004 in 5 italian cardiology centers were included in this study. cardioverter-defibrillators:Cpt codes covered if selection criteria are met:Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed. number of well-designed studies have shown the effectiveness of the icd in high-risk patients who have already experienced a myocardial infarction (mi). for patients with nidcm, there was a reduction in the mortality hazard ratio for icd therapy compared to control but it was also not statistically significant (hazard ratio 0.  however, conventional transvenous icd (tv-icd) systems come with the inherent drawbacks of transvenous leads, including:Risks at the time of insertion -- cardiac perforation, pericardial effusion, cardiac tamponade, hemothorax, pneumothorax. there are no prospective clinical studies demonstrating that use of aeds by non-medical persons for home use improves health outcomes, aetna considers wearable automatic external cardioverter defibrillators (wearable cardioverter-defibrillators or wcds) medically necessary only on an exception basis for high-risk patients who meet the criteria for an icd and who either refuse an icd or have a contraindication to icd placement. there was a significant reduction in all-cause mortality in the icd group compared to the placebo group (hazard ratio compared to control = 0. evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters). diagnostic code (acute mi), and then matched to device-recorded data. sure documentation proves the device is necessary, and determine the proper diagnosis code.

Establish Medical Necessity for Implantable Cardioverter-defibrillators

a prospective, non-randomized, multi-center trial, weiss et al (2013) evaluated the safety and effectiveness of the s-icd system for the treatment of life-threatening ventricular arrhythmias (vt/vf).  the secondary outcome measure was survival-free from inappropriate icd therapy or system revision. a single-blind, randomised, multi-center, non-inferiority clinical trial (shockless implant evaluation [simple]), healey et al (2015) compared the safety and effectiveness of icd implantation without dft testing versus the standard of icd implantation with dft testing. coverage, coding and billing information for Single Chamber and Dual Chamber Permanent Pacemakers defined by the SSA, NCD and CMS manuals, including contractor determined coding criteria.  a questionnaire was sent to all uk hospitals implanting s-icds. as primary prevention, the literature shows the icd is superior to conventional anti-arrhythmic drug therapy in patients who have survived a myocardial infarction and who have spontaneous, non-sustained vt, a low ejection fraction, inducible vt at electrophysiological study, and whose vt is not suppressed by procainamide. hcpcs code related to the cpb:Injection, amiodarone hcl, 30 mg.  exclusion criteria included pregnancy, awaiting transplantation, participation in another randomised trial, unavailability for follow-up, or if it was expected that the icd would have to be implanted on the right-hand side of the chest. these survivors have various therapeutic options such as anti-arrhythmic drugs, radiofrequency or surgical ablation of vt focus, or implantable cardioverter-defibrillators (icds). indications for icd and cardiac resynchronization therapy for prevention of sudden cardiac death. considers icds with hemodynamic (fluid status) monitoring experimental and investigational because of a lack of reliable evidence of efficacy and safety.  furthermore, by using far-field electrograms better tachyarrhythmia discrimination when compared to tv-icds has been reported.  nevertheless, given the absence of intra-cavitary leads, the s-icd is unable to offer pacing (apart from short-term post-shock pacing). as primary prevention, the literature shows the icd is superior to conventional anti-arrhythmic drug therapy in patients who have survived a myocardial infarction and who have spontaneous, non-sustained vt, a low ejection fraction, inducible vt at electrophysiological study, and whose vt is not suppressed by procainamide.  the authors concluded that future results from ongoing clinical studies will determine the s-icd system's long-term performance, and better define suitable patient profiles.  no s-icd were extracted, but 3 tv- icd were extracted due to infection (n = 1) and lead failure (n = 2).  median duration of follow-up was lower for s-icd (20 months) than for tv-cd (36 months, p = 0.

cpt codes related to the cpb:Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement;. center for medicare and medicaid services (cms) determined that the evidence is adequate to conclude that an icd is reasonable and necessary for the following: (i) patients with ischemic dilated cardiomyopathy (idcm), documented prior mi, and a measured lvef of less than or equal to 35 %; (ii) patients with non-ischemic dilated cardiomyopathy (nidcm) greater than 9 months with a measured ef less than or equal to 35 %. et al (2013) stated that the s-icd has recently been approved for commercial use in europe, new zealand and the united states. thus, the risks and benefits of prophylactic icd implantation in persons with mutations of this gene are unknown. evaluation of single or dual chamber pacing cardioverter-defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters).  the age of the subcutaneous icd recipients indicates that they may be a more active and more prone to over-sensing owing to subcutaneous sensing challenges or t-wave double counting ….  survival of a hypothetical cohort of patients was assessed according to 2 strategies-routine dft testing at time of icd implant versus no dft testing.  survival free of inappropriate therapy or system revision was 89 % for s-icd and 25 % for tv-icd systems (log-rank test, p = 0. they found that the long-term survival of patients with sustained ventricular tachyarrhythmias after mi, with depressed lv function, is significantly better with an icd than with amiodarone therapy, even when stratified according to the results of the ep study. worldwide experience with a totally subcutaneous implantable defibrillator: early results from the effortless s-icd registry.  exclusion criteria included pregnancy, awaiting transplantation, participation in another randomised trial, unavailability for follow-up, or if it was expected that the icd would have to be implanted on the right-hand side of the chest., an uptodate review on “subcutaneous implantable cardioverter defibrillators” (weinstock et al, 2015) states that “icd systems consist of a pulse generator, typically placed in the pectoral region, and one or more leads which attach the pulse generator to the heart, most commonly to the endocardium via transvenous insertion.  these investigators evaluated the impact of dft testing of implanted icds on survival.  the primary safety end-point was the 180-day s-icd system complication-free rate compared with a pre-specified performance goal of 79 %.   in the best of all possible worlds, the subcutaneous icd will grow and evolve into a device whose design supports the growth of features and capabilities that can evolve with the patient’s condition.  survival free of inappropriate therapy or system revision was 89 % for s-icd and 25 % for tv-icd systems (log-rank test, p = 0.   codes requiring a 7th character are represented by "+":Implantable cardioverter-defibrillators:Cpt codes covered if selection criteria are met:Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator.

View Cardiac Implantables CPT Codes head-to-head comparison of arrhythmia discrimination performance of subcutaneous and transvenous icd arrhythmia detection algorithms: the start study. until definitive data from prospective, randomized trials are available it is premature to recommend use of these tools to guide icd therapy. until definitive data from prospective, randomized trials are available it is premature to recommend use of these tools to guide icd therapy. of complications at the time of tv-icd range from 3 to 6 % of implants. there are no prospective clinical studies demonstrating that use of aeds by non-medical persons for home use improves health outcomes, aetna considers wearable automatic external cardioverter defibrillators (wearable cardioverter-defibrillators or wcds) medically necessary only on an exception basis for high-risk patients who meet the criteria for an icd and who either refuse an icd or have a contraindication to icd placement. of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) (list separately in addition to code for primary procedure).  these researchers studied consecutive patients less than 20 years of age who received an icd over a 4-year period in 2 scottish centers. et al (2013) compared the performance of s-icd and tv-icd systems in children and teenagers. meets above-listed criteria for an icd and is awaiting heart transplantation; or.  these investigators evaluated current clinical decision making regarding dft testing during icd implantation.  the authors concluded that the s-icd is an important innovation in icd technology.  the authors concluded that the impact of dft testing on 5-year survival in icd patients, if it exists, is small. schlapfer and colleagues (2002) compared the long-term survival rates of patients with sustained ventricular tachyarrhythmia after mi who were treated according to the results of ep study either with amiodarone or an icd. literature indicates icds are now widely used for the secondary prevention of sudden cardiac death due to vf or vt. without remote monitoring capability, it will be difficult to track the occurrences of these episodes in the population of patients who receive the subcutaneous icd. the mean age at icd implantation was 52 +/- 14 years, whereas the average time from orthotopic heart transplant to icd implant was 8 +/- 6 years. evaluation of single or dual chamber pacing cardioverter-defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters).

the fda noted that, because the s-icd system memory stores data from only the 22 most recent arrhythmia episodes, there may have been other detected episodes that could not be analyzed by investigators. codes not covered for indications listed in the cpb:External defibrillator with integrated electrocardiogram analysis.-10 codes covered if selection criteria are met:Chagas disease with heart involvement. or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing. thus, the risks and benefits of prophylactic icd implantation in persons with mutations of this gene are unknown. codes covered if selection criteria are met:Cardioverter-defibrillator, dual chamber (implantable).  they also measured an inhomogeneous, center-dependent dft testing behavior, which suggested the importance of defining a common guideline for icd implant testing., an uptodate review on “subcutaneous implantable cardioverter defibrillators” (weinstock et al, 2015) states that “icd systems consist of a pulse generator, typically placed in the pectoral region, and one or more leads which attach the pulse generator to the heart, most commonly to the endocardium via transvenous insertion. analysis of pacing cardioverter-defibrillator (includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response); single chamber or wearable cardioverter-defibrillator system, without reprogramming. a total of 2,521 patients were enrolled, 847 of whom were assigned to placebo plus conventional heart failure therapy, 845 to amiodarone plus conventional heart failure therapy, and 829 to single lead icd plus conventional heart failure therapy. the potential use of genetic screening for desmoglein 2 mutations is for identifying persons at increased risk of arvd/c who are candidates for prophylactic icd. the icd is generally accepted as treatment for patients who have experienced an episode of vf not accompanied by an acute myocardial infarction or other transient or reversible causes (e. meets above-listed criteria for an icd and has a systemic infectious process or other temporary condition that precludes icd implantation; or. codes covered if selection criteria are met:Cardioverter-defibrillator, other than single or dual chamber (implantable) [subcutaneous cardioverter-defibrillators].  the authors concluded that the s-icd is an important innovation in icd technology. head-to-head comparison of arrhythmia discrimination performance of subcutaneous and transvenous icd arrhythmia detection algorithms: the start study.  the enhancements will provide multiple reasons for subcutaneous icd to exist”.

there was a significant reduction in all-cause mortality in the icd group compared to the placebo group (hazard ratio compared to control = 0. literature indicates icds are now widely used for the secondary prevention of sudden cardiac death due to vf or vt.-10 codes covered if selection criteria are met:Chagas disease with heart involvement. defines the requirements for coverage of an implantable cardioverter-defibrillator (icd) insertion in national coverage determination (ncd) 20.  although these data are reassuring and comparable to tv-icd success rates, the overall number of treated episodes is incredibly small in comparison with the data on transvenous defibrillator therapies delivered outside the hospital, over the life of the device, that are available for analysis in tens of thousands of patients. considers icds with hemodynamic (fluid status) monitoring experimental and investigational because of a lack of reliable evidence of efficacy and safety. of single or dual chamber implantable defibrillator electrode(s); by thoracotomy. an accompanying editorial of the afore-mentioned study, saxon noted that “over the follow-up interval reported in this study, the subcutaneous icd terminated spontaneously occurring vt/vf in 6. ongoing and planned studies will better define the role of using non-invasive tests to select patients for icd therapy. madit ii, the multi-center autonomic defibrillator implantation trial ii stopped early for mortality reduction, has icd therapy earned its evidence-based credentials? analysis of pacing cardioverter-defibrillator (includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response); single chamber or wearable cardioverter-defibrillator system, without reprogramming. center for medicare and medicaid services expanded coverage of icds to persons with nidcm, based primarily on the results of the sudden cardiac death in heart failure trial (scd-heft), a prospective randomized trial to determine whether amiodarone or an icd will improve survival compared to placebo in patients with nyha class ii and class iii heart failure and reduced lvef less than 35 %. threshold (dft) testing during implantable cardioverter-defibrillator implantation:Gula et al (2008) noted that defibrillation threshold (dft) testing is generally performed during implantation of icds to assess sensing and termination of vf.  the subcutaneous icd does not encompass these features nearly as much as the transvenous device.  median duration of follow-up was lower for s-icd (20 months) than for tv-cd (36 months, p = 0. testing of single or dual chamber pacing cardioverter-defibrillator pulse generator. and chung (2014) noted that with advancements in icd technology, the practice of performing dft testing at the time of implantation has been questioned.

 clinical trials demonstrating the effectiveness of icds in prevention of scd have, however, all used some form of defibrillation testing.  no s-icd were extracted, but 3 tv- icd were extracted due to infection (n = 1) and lead failure (n = 2).  a total of 9 s-icd were implanted in 9 patients; 8 tv-icd were implanted in 6 patients; 2 were redo procedures.  the authors concluded that the findings of this study supported the safety and effectiveness of the s-icd system for the treatment of life-threatening ventricular arrhythmias. indications for icd and cardiac resynchronization therapy for prevention of sudden cardiac death.  these investigators recruited patients aged older than 18 years receiving their first icd for standard indications at 85 hospitals in 18 countries worldwide. a total of 2,521 patients were enrolled, 847 of whom were assigned to placebo plus conventional heart failure therapy, 845 to amiodarone plus conventional heart failure therapy, and 829 to single lead icd plus conventional heart failure therapy. or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber. and chung (2014) noted that with advancements in icd technology, the practice of performing dft testing at the time of implantation has been questioned.  current data from initial clinical studies and post-commercialization "real-life" case series, including over 700 patients, have so far been promising and shown that the s-icd successfully converts induced and spontaneous vt/vf episodes with associated complication and inappropriate shock rates similar to that of tv-icds. a single-blind, randomised, multi-center, non-inferiority clinical trial (shockless implant evaluation [simple]), healey et al (2015) compared the safety and effectiveness of icd implantation without dft testing versus the standard of icd implantation with dft testing.. food and drug administration (fda) has approved the subcutaneous implantable defibrillator (s-icd) system (cameron health, san clemente, ca) "to provide defibrillation therapy for the treatment of life-threatening ventricular tachyarrhythmias in patients who do not have symptomatic bradycardia, incessant ventricular~tachycardia, or spontaneous, frequently recurring ventricular tachycardia that is reliably terminated with antitachycardia pacing.  the authors concluded that in real-world use in children and teenagers, s-icd may offer similar survival benefit to tv-cd, with a lower incidence of complications requiring reoperation. a prospective, non-randomized, multi-center trial, weiss et al (2013) evaluated the safety and effectiveness of the s-icd system for the treatment of life-threatening ventricular arrhythmias (vt/vf). the fda reviewed safety data based on the entire 321-patient study population to identify complications that can occur during and after implantation of the s-icd system. the fda approval was based upon the results of a 321-patient study in which 304 patients were successfully implanted with the s-icd system. multi-center autonomic defibrillator implantation trial ii (madit ii) was stopped early because of a 30 % reduction in mortality in patients randomized to receive an icd (coats, 2002).