CPT® Code 0325T

Deleted

1. Indications

The repositioning of a subcutaneous implantable defibrillator electrode and/or pulse generator is indicated in the following situations:

• Device Malfunction The procedure may be necessary when the defibrillator fails to respond appropriately to cardiac events, indicating a need for repositioning to restore functionality.

2. Procedure

The procedure for repositioning the subcutaneous implantable defibrillator electrode and/or pulse generator involves several critical steps:

• 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: Preparation of the Surgical Site The anterior and left lateral chest areas are thoroughly prepped and draped to maintain a sterile field, minimizing the risk of infection.
• Step 3: Incision A surgical incision is made in the skin over the pulse generator, and the incision is carried down to expose the device, allowing access for repositioning.
• Step 4: Electrode Repositioning The electrode is disconnected from the pulse generator. A sheath is then advanced over the electrode to facilitate its movement to a more distal position. The anchoring tip of the electrode is worked free, and the electrode is repositioned as necessary.
• Step 5: Pulse Generator Repositioning To reposition the pulse generator, the existing subcutaneous pouch is further excised in a superior, inferior, lateral, or anterior direction, depending on the required adjustment. The electrode is reconnected to the pulse generator, which is then inserted back into the newly adjusted subcutaneous pouch.
• Step 6: Device Programming and Testing After the repositioning, the device is programmed, and an arrhythmia is induced to test the device's response and ensure it functions correctly.
• Step 7: Securing the Device Once the electrode and/or pulse generator are positioned optimally, they are secured in place, and the incision is closed to complete the procedure.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate complications and ensuring that the defibrillator responds appropriately to cardiac events. Patients may require follow-up appointments to assess the device's functionality and to monitor for any signs of infection or other complications at the incision site. Proper wound care instructions should be provided to the patient to facilitate healing and minimize risks.