CPT® Code 0324T

Deleted

1. Indications

The removal of a subcutaneous defibrillator electrode, as described by CPT® Code 0324T, is indicated in specific clinical scenarios. These may include:

• Device Replacement: When a patient requires an upgrade or replacement of their existing implantable cardioverter-defibrillator (ICD) system.
• Complications: In cases where the patient experiences complications related to the electrode, such as infection, lead malfunction, or discomfort.
• Device Explantation: When the decision is made to completely remove the defibrillator system due to various medical reasons.

2. Procedure

The procedure for the removal of a subcutaneous defibrillator electrode involves several critical steps to ensure safe and effective removal.

• Step 1: The patient is positioned appropriately, and the anterior and left chest area is prepped and draped to maintain a sterile field. This preparation is essential to minimize the risk of infection during the procedure.
• Step 2: An incision is made in the subcutaneous pouch located in the left chest area to expose the end of the electrode that is connected to the pulse generator. The electrode is then secured with a clamp to facilitate safe handling during the removal process.
• Step 3: The surgeon identifies the anchoring site of the electrode, which is typically located in the mid sternum area. An incision is made in the skin at this site, and the incision is carried down to expose the defibrillator electrode.
• Step 4: The anchoring tip of the electrode is excised from the surrounding tissue and cut from the electrode itself. This step is crucial for detaching the electrode from its anchoring point.
• Step 5: Using gentle traction, the lead is carefully pulled through the subcutaneous tissue, allowing it to exit through the incision made in the left lateral chest over the pulse generator. This step requires precision to avoid damaging surrounding tissues.
• Step 6: Finally, the incisions made during the procedure are closed with sutures, ensuring proper healing and minimizing scarring.

3. Post-Procedure

After the removal of the subcutaneous defibrillator electrode, patients are typically monitored for any immediate complications. Post-procedure care may include pain management, wound care instructions, and follow-up appointments to assess healing. Patients should be advised to watch for signs of infection, such as increased redness, swelling, or discharge at the incision site. Recovery time may vary depending on individual patient factors, but most patients can expect to resume normal activities within a few days, barring any complications.