CPT® Code 0319T

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1. Indications

The insertion or replacement of a subcutaneous implantable defibrillator system is indicated for patients who are at risk of life-threatening ventricular tachyarrhythmias. These conditions may include, but are not limited to, the following:

• Cardiac Arrhythmias Patients with a history of abnormal heart rhythms that can lead to sudden cardiac arrest.
• Ventricular Tachycardia Individuals experiencing fast heartbeats originating from the ventricles, which can be life-threatening if not managed.
• Previous Cardiac Arrest Patients who have previously suffered from cardiac arrest due to arrhythmias, indicating a high risk for recurrence.
• Inherited Arrhythmia Syndromes Individuals with genetic conditions that predispose them to dangerous heart rhythms.

2. Procedure

The procedure for the insertion or replacement of a subcutaneous implantable defibrillator system involves several critical steps to ensure proper placement and functionality of the device. The process begins with the patient being placed under general anesthesia or monitored anesthesia care (MAC), along with local anesthesia to minimize discomfort during the procedure. The surgical team prepares the anterior and left lateral chest area by cleaning and draping it to maintain a sterile field. An incision is then made on the left lateral side of the chest, specifically between the 5th and 6th intercostal space along the mid-axillary line. This incision allows for the creation of a subcutaneous pouch where the pulse generator will be securely placed. Next, the surgeon locates the tip of the xiphoid process at the base of the sternum and makes a midline incision at this point, extending horizontally toward the left lateral chest. Using an electrode insertion tool, the tripolar parasternal electrode is carefully tunneled just beneath the skin along the rib line from the xiphoid to the subcutaneous pouch in the left chest. To complete the distal insertion, a small incision is made in the mid sternum, allowing the distal tip of the electrode to be tunneled from the xiphoid to the superior sternum. This precise placement positions the distal sensing electrode adjacent to the manubriosternal junction and the proximal sensing electrode next to the xiphoid process, with the shocking coil situated between these two points. Once the electrode is in place, it is connected to the pulse generator, which is then inserted into the subcutaneous pouch created earlier. The pulse generator is programmed externally to ensure it is set to respond appropriately to arrhythmias. An arrhythmia is induced to test the device's response, and the patient is closely monitored during this phase to confirm that the device functions as intended. After confirming the device's effectiveness, the electrode and pulse generator are secured in place, and the incisions are meticulously closed to promote proper healing.

3. Post-Procedure

After the insertion or replacement of the subcutaneous implantable defibrillator system, patients are typically monitored in a recovery area to ensure stability and assess for any immediate complications. Post-procedure care may include pain management, monitoring for signs of infection at the incision sites, and ensuring that the device is functioning correctly. Patients are often advised on activity restrictions to allow for proper healing and to avoid placing stress on the surgical site. Follow-up appointments are essential to evaluate the device's performance and make any necessary adjustments to the programming. Additionally, patients may receive education on recognizing symptoms of arrhythmias and when to seek medical attention, ensuring they are well-informed about their condition and the role of the defibrillator in their care.