CPT® Code 0322T

Deleted

1. Indications

The removal of a subcutaneous implantable defibrillator pulse generator, as described by CPT® Code 0322T, is indicated in specific clinical scenarios. These may include:

• Device Malfunction: The pulse generator may need to be removed due to malfunction or failure of the device, which could compromise its effectiveness in delivering appropriate therapy.
• Infection: In cases where there is an infection at the site of the pulse generator, removal may be necessary to prevent further complications and to allow for appropriate treatment.
• Device Upgrade: If a patient is transitioning to a newer model of a defibrillator, the old pulse generator may be removed as part of the upgrade process, although this code specifically pertains to removal without replacement.
• Patient Request: Patients may request removal of the device for personal reasons, including discomfort or lifestyle changes, which may warrant the procedure.

2. Procedure

The procedure for the removal of the subcutaneous implantable defibrillator pulse generator involves several critical steps:

• Step 1: The patient is positioned appropriately, and general anesthesia or monitored anesthesia care (MAC) is administered, along with local anesthesia to ensure comfort during the procedure.
• Step 2: The surgical site, typically located in the left chest area, is prepped and draped to maintain a sterile environment, minimizing the risk of infection.
• Step 3: An incision is made in the skin directly over the pulse generator. The incision is carefully extended to allow access to the device beneath the skin.
• Step 4: The pulse generator is meticulously dissected free from the surrounding tissue, ensuring that no damage occurs to the electrode or surrounding structures.
• Step 5: Once the pulse generator is exposed, the electrode is identified and disconnected from the device, allowing for its complete removal from the subcutaneous pouch.
• Step 6: If the old pulse generator is not being replaced, the subcutaneous pouch is closed at this point. If a new pulse generator is to be inserted, the new device is connected to the existing electrode.
• Step 7: The new pulse generator is then inserted into the subcutaneous pouch, and it is programmed externally to ensure it is functioning correctly.
• Step 8: An arrhythmia is induced to test the device's response, and the patient is monitored closely during this phase to confirm appropriate device functionality.
• Step 9: After confirming the device is functioning as intended, the electrode and device are secured in place, and the incision is closed using appropriate suturing techniques.

3. Post-Procedure

Post-procedure care following the removal of the subcutaneous implantable defibrillator pulse generator involves monitoring the patient for any immediate complications, such as bleeding or infection at the incision site. Patients are typically advised to keep the area clean and dry, and to follow specific instructions regarding activity restrictions to promote healing. Follow-up appointments may be scheduled to assess the surgical site and ensure proper recovery. If a new pulse generator was inserted, additional monitoring may be required to confirm the device's functionality and to adjust settings as necessary.