CPT® Code 0520T

1. Indications

The procedure for the removal and replacement of the pulse generator for a wireless cardiac stimulator is indicated for patients who require ongoing left ventricular pacing and whose existing battery has reached its end of life. This procedure is particularly relevant for individuals experiencing:

• Inadequate Cardiac Resynchronization Therapy (CRT) - Patients who do not achieve effective CRT due to limitations of conventional pacing methods.
• Anatomic Challenges - Individuals who have experienced difficulties with the placement of LV pacing wires due to anatomical issues.
• Lead Dislodgment - Patients who have had leads dislodged, leading to unintended nerve stimulation and poor ventricular response.
• Battery End of Life - Patients whose pulse generator battery has reached its end of life and requires replacement to maintain device functionality.

2. Procedure

The procedure for the removal and replacement of the pulse generator battery involves several critical steps to ensure the safe and effective transition to a new battery. The following steps outline the process:

• Step 1: Incision An incision is made over the previous battery implant scar site, which is typically located to the left of the existing transmitter pocket. This approach minimizes additional trauma to the surrounding tissue.
• Step 2: Accessing the Pocket The subcutaneous pocket that houses the battery is accessed through the incision. Care is taken to avoid damaging surrounding structures during this process.
• Step 3: Battery Removal The old battery is carefully removed from the pocket. This step is crucial to ensure that no residual components are left behind that could interfere with the new device.
• Step 4: Disconnecting the Transmitter Cable A torque wrench is utilized to disconnect the transmitter cable from the old battery. This ensures a secure and proper disconnection without damaging the cable.
• Step 5: Inspection The cable connection is inspected for any signs of fluid leaks or foreign substances that may have accumulated. This step is vital for ensuring the integrity of the system.
• Step 6: Connecting the New Battery The transmitter’s cable is then inserted into the new battery, and the screws are tightened to secure the connection. This ensures that the new battery is properly integrated into the existing system.
• Step 7: Positioning the New Battery The new battery is positioned into the existing pocket and sutured into place. Proper positioning is essential for the stability and functionality of the device.
• Step 8: System Evaluation The entire system is evaluated for proper functioning using the previous settings. The programmer checks for appropriate biventricular pacing capture and makes any necessary adjustments to optimize performance.
• Step 9: Closing the Pocket Once the system is confirmed to be functioning correctly, the subcutaneous pocket is closed, completing the procedure.

3. Post-Procedure

After the procedure, patients are typically monitored for any immediate complications related to the surgery. Expected recovery includes managing any discomfort at the incision site and ensuring that the new battery is functioning as intended. Follow-up appointments may be scheduled to assess the performance of the wireless cardiac stimulator and to make any further adjustments to the programming as needed. Patients should be advised on signs of infection or other complications that may arise post-operatively, and they should be instructed to follow up with their healthcare provider for routine evaluations of their cardiac pacing system.