How To Use CPT Code 0425T

CPT 0425T describes the insertion or replacement of the sensing lead for a neurostimulator system used to treat central sleep apnea. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0425T?

CPT 0425T can be used to describe the insertion or replacement of the sensing lead for a neurostimulator system used to treat central sleep apnea. This code is used when the provider makes a small incision in the skin over the azygos vein and places the lead through a catheter or over a guide wire inserted into the vein. The lead is then connected to the pulse generator, tested for proper function, and the incision is closed.

2. Official Description

The official description of CPT code 0425T is: ‘Insertion or replacement of neurostimulator system for treatment of central sleep apnea; sensing lead only.’

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. A small incision is made in the skin over the azygos vein.
3. The provider places the sensing lead through a catheter or over a guide wire inserted into the vein, under imaging guidance.
4. A separate incision is made to access the pulse generator.
5. The provider connects the sensing lead to the pulse generator.
6. The lead and generator are tested for proper function.
7. Once satisfied with the placement and function, the provider closes the incision.

4. Qualifying circumstances

Patients eligible to receive CPT 0425T services are those with central sleep apnea, a condition characterized by the arrest of breathing during sleep that can impair cardiovascular function and lead to death. The neurostimulator system consists of a transvenously placed right or left stimulation lead, a sensing lead, and an implantable pulse generator. This code should only be reported for the insertion or replacement of the sensing lead in the system.

5. When to use CPT code 0425T

CPT code 0425T should be used when the provider is performing the insertion or replacement of the sensing lead for a neurostimulator system used to treat central sleep apnea. This code should not be used for removal only without replacement or repositioning of only the sensing lead.

6. Documentation requirements

To support a claim for CPT 0425T, the provider must document the following information:

• Patient’s diagnosis of central sleep apnea
• Details of the procedure, including the specific incisions made and the placement of the sensing lead
• Testing of the lead and generator for proper function
• Closure of the incision
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 0425T, ensure that the procedure involves the insertion or replacement of the sensing lead for a neurostimulator system used to treat central sleep apnea. This code should not be reported with other codes for removal or repositioning of the lead. It is important to consider the location of the testing and code accordingly for the professional and technical components.

8. Historical information

CPT 0425T was added to the Current Procedural Terminology system on January 1, 2016. There have been no updates to the code since its addition.

9. Examples

1. A provider inserts a sensing lead for a neurostimulator system to treat central sleep apnea in a patient.
2. A patient requires the replacement of the sensing lead in their neurostimulator system for the treatment of central sleep apnea.
3. A provider performs the insertion of the sensing lead for a neurostimulator system in a patient with central sleep apnea.
4. A patient with central sleep apnea undergoes the replacement of the sensing lead in their neurostimulator system.
5. A provider inserts a sensing lead for a neurostimulator system used to treat central sleep apnea in a patient undergoing surgery.
6. A patient with central sleep apnea requires the replacement of the sensing lead in their neurostimulator system due to malfunction.
7. A provider performs the insertion of the sensing lead for a neurostimulator system in a patient with central sleep apnea during a scheduled procedure.
8. A patient’s neurostimulator system for central sleep apnea needs the replacement of the sensing lead due to wear and tear.
9. A provider inserts a sensing lead for a neurostimulator system to treat central sleep apnea in a patient with comorbid cardiovascular conditions.
10. A patient with central sleep apnea undergoes the replacement of the sensing lead in their neurostimulator system to improve respiratory function during sleep.