© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 0268T refers to the procedure involving the implantation or replacement of a carotid sinus baroreflex activation device, specifically focusing on the pulse generator component. This device is utilized in patients suffering from refractory hypertension, a condition where blood pressure remains high despite the use of multiple antihypertensive medications. The carotid sinus baroreflex plays a critical role in regulating blood pressure and heart rate by transmitting electrical signals to the brainstem, which in turn modulates the autonomic nervous system's response to maintain cardiovascular stability. In cases of refractory hypertension, the natural ability of this reflex to control blood pressure is compromised. By implanting a baroreflex activation device, the electrical activity in the carotid baroreceptor afferent nerves is enhanced, tricking the brainstem into perceiving elevated arterial blood pressure. This prompts the central nervous system to adjust sympathetic and vagal nerve activity, ultimately leading to a reduction in both blood pressure and heart rate. The procedure involves careful surgical techniques, including the placement of electrodes on the carotid sinus wall and the implantation of a pulse generator, which is programmed to deliver specific electrical impulses to achieve the desired therapeutic effect.
© Copyright 2025 Coding Ahead. All rights reserved.
The implantation or replacement of a carotid sinus baroreflex activation device is indicated for patients with refractory hypertension, which is characterized by persistently high blood pressure that does not respond adequately to standard antihypertensive treatments. This condition can lead to significant cardiovascular risks and complications, making effective management crucial.
The procedure for the implantation or replacement of the carotid sinus baroreflex activation device involves several detailed steps to ensure proper placement and functionality of the device. Initially, an incision is made over the carotid bifurcation on one side of the neck to expose the common carotid artery. Care is taken to identify and protect the vagus nerve during this process. The carotid artery bifurcation is then mobilized circumferentially, ensuring that the neurovascular bundle within the bifurcation remains undisturbed. Following this, the first electrode is positioned on the bifurcation area of the carotid sinus. This electrode is connected to the battery-powered impulse generator (IPG), and its placement is tested to evaluate the hemodynamic response. If necessary, the electrode is repositioned until an optimal hemodynamic response is achieved, after which it is sutured in place. The same procedure is then repeated on the contralateral side to ensure bilateral functionality. Subsequently, the leads from the electrodes are tunneled to the infraclavicular region, where a subcutaneous pocket for the IPG is created. An incision is made in the skin to fashion this pocket, and the leads are connected to the IPG. The impulse generator is then tested to confirm its functionality, and the optimal frequency and intensity of the electrical impulses are determined and programmed into the device. Once it is confirmed that both the leads and the IPG are operating correctly and that the desired reduction in blood pressure and heart rate has been achieved, the IPG is placed into the pocket, secured to the underlying tissue, and the pocket is closed with sutures.
After the procedure, patients are typically monitored for any immediate complications related to the surgery, such as bleeding or infection at the incision site. The expected recovery period may vary, but patients are generally advised to follow up with their healthcare provider to assess the functionality of the device and the effectiveness of blood pressure management. Additional considerations may include instructions on activity restrictions, wound care, and signs of potential complications that should prompt immediate medical attention.
| Short Descr | IMPLT/RPL CRTD SNS DEV GEN | Medium Descr | IM/REPL CARTD SINS BARREFLX ACT DEV PLS GEN ONLY | Long Descr | Implantation or replacement of carotid sinus baroreflex activation device; pulse generator only (includes intra-operative interrogation, programming, and repositioning, when performed) | Status Code | Carriers Price the Code | Global Days | YYY - Carrier Determines Whether Global Concept Applies | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | T2D - Other tests - other | MUE | 1 | CCS Clinical Classification | 59 - Other OR procedures on vessels of head and neck |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2012-01-01 | Added | First appearance in code book |
| 2011-07-01 | Added | Code implemented |
Get instant expert-level medical coding assistance.