CPT® Code 0271T

1. Indications

The procedure described by CPT® Code 0271T is indicated for patients experiencing issues related to the carotid sinus baroreflex activation device. These indications include:

• Mechanical Malfunction - The device may fail to operate as intended, necessitating revision or removal.
• Pain - Patients may experience discomfort or pain associated with the device, prompting intervention.
• Infection - The presence of infection at the implantation site may require the removal of the device.
• Extravascular Tissue Stimulation - Unintended stimulation of surrounding tissues can lead to complications, warranting revision.
• Bradycardia - The device may contribute to abnormally slow heart rates, necessitating adjustments or removal.
• Failure to Respond to Therapy - If the device does not provide the expected therapeutic benefits for hypertension, revision may be required.

2. Procedure

The procedure for the revision or removal of the carotid sinus baroreflex activation device, as outlined in CPT® Code 0271T, involves several critical steps:

• Step 1: Incision and Exposure - The existing incision over the subcutaneous pocket where the pulse generator is located is reopened. This allows access to the generator and the distal aspect of the leads.
• Step 2: Assessment of Connections - The connections between the leads and the impulse generator are carefully checked. If any issues are identified, the connections may be repositioned or revised to ensure proper functionality.
• Step 3: Evaluation of Leads - After confirming the generator is functioning correctly, attention shifts to the leads. If one or both leads are found to be ineffective in delivering impulses to the carotid sinuses, the insertion site(s) at the carotid artery bifurcation is exposed for further evaluation.
• Step 4: Lead Revision - Depending on the assessment, one or both leads may be repositioned or revised to restore their functionality.
• Step 5: Programming the Generator - Once the leads and generator are confirmed to be operational, the optimal frequency and intensity of impulses are determined. The generator is programmed accordingly, and adjustments are made to the placement of the leads until the desired reduction in blood pressure and heart rate is achieved.
• Step 6: Closure - After successful programming, the implantable pulse generator (IPG) is placed back into the pocket, sutured to the underlying tissue, and the incision is closed.

3. Post-Procedure

Post-procedure care following the revision or removal of the carotid sinus baroreflex activation device involves monitoring the patient for any immediate complications, such as infection or excessive bleeding. Patients may be advised on activity restrictions to promote healing at the incision site. Follow-up appointments are typically scheduled to assess the effectiveness of the device after programming adjustments and to ensure that the patient is responding positively to the therapy. Any signs of complications or adverse reactions should be reported to the healthcare provider promptly for further evaluation and management.