CPT® Code 0323T

Deleted

1. Indications

The procedure associated with CPT® Code 0323T is indicated for patients who require the removal and replacement of a subcutaneous implantable defibrillator pulse generator. This may be necessary due to various reasons, including:

• Device Malfunction: The existing pulse generator may not be functioning correctly, necessitating replacement to ensure effective cardiac monitoring and therapy.
• Battery Depletion: The pulse generator may have reached the end of its battery life, requiring a new device to maintain continuous operation.
• Upgrading Technology: Advances in defibrillator technology may prompt the replacement of an older model with a newer version that offers improved features or capabilities.
• Infection or Complications: In cases where the existing device is associated with infection or other complications, removal and replacement may be warranted to ensure patient safety and device efficacy.

2. Procedure

The procedure for CPT® Code 0323T involves several critical steps, which are detailed as follows:

• Step 1: Anesthesia Administration - The patient is placed under general anesthesia or monitored anesthesia care (MAC), along with local anesthesia to ensure comfort during the procedure.
• Step 2: Skin Preparation - The area over the left chest, where the subcutaneous implantable defibrillator generator is located, is thoroughly prepped and draped to maintain a sterile field.
• Step 3: Incision - A surgical incision is made in the skin directly over the pulse generator, allowing access to the device beneath the skin.
• Step 4: Dissection - The pulse generator is carefully dissected free from the surrounding tissue to avoid damage to the device and surrounding structures.
• Step 5: Electrode Disconnection - The electrode connected to the pulse generator is identified and disconnected, facilitating the removal of the old generator.
• Step 6: Generator Removal - The old pulse generator is removed from the subcutaneous pouch, completing the first part of the procedure.
• Step 7: Replacement (if applicable) - If a new pulse generator is being inserted, it is connected to the existing electrode and carefully placed into the subcutaneous pouch.
• Step 8: Device Programming - The new pulse generator is programmed externally, and an arrhythmia is induced to test the device's functionality and ensure it responds appropriately.
• Step 9: Securing the Device - The electrode and the newly placed pulse generator are secured in their position to prevent movement or dislodgment.
• Step 10: Incision Closure - Finally, the surgical incision is closed, completing the procedure.

3. Post-Procedure

After the procedure coded as CPT® 0323T, patients are typically monitored for any immediate complications and to ensure the new pulse generator is functioning correctly. Post-procedure care may include pain management, wound care instructions, and follow-up appointments to assess the device's performance and the patient's recovery. Patients may also be advised on activity restrictions and signs of potential complications, such as infection or device malfunction, that should prompt immediate medical attention.