CPT® Code 0571T

Official Description

Insertion or replacement of implantable cardioverter-defibrillator system with substernal electrode(s), including all imaging guidance and electrophysiological evaluation (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters), when performed

Common Language Description

The procedure described by CPT® Code 0571T involves the insertion or replacement of a subcutaneous implantable cardioverter-defibrillator (SICD) system that utilizes substernal electrode(s). This type of device is specifically designed to treat ventricular arrhythmias in patients who require an implantable cardioverter-defibrillator (ICD) but have limited access to their venous system. Unlike traditional ICDs, the SICD system does not enter the vascular system or make contact with the beating heart, making it a suitable option for patients with certain anatomical or medical considerations. The procedure includes comprehensive imaging guidance and an electrophysiological evaluation, which encompasses several critical assessments such as defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and the programming or reprogramming of sensing or therapeutic parameters. This thorough evaluation ensures that the device is optimally configured to respond to the patient's specific cardiac needs, enhancing the effectiveness of the SICD system in preventing life-threatening arrhythmias.

1. Indications

The insertion or replacement of a subcutaneous implantable cardioverter-defibrillator (SICD) system with substernal electrode(s) is indicated for patients who:

Require an ICD: Patients who have a clinical need for an implantable cardioverter-defibrillator due to a history of life-threatening ventricular arrhythmias.
Have Limited Venous Access: Patients who may not have suitable venous access for traditional ICD placement, making the SICD a viable alternative.

2. Procedure

The procedure for the insertion or replacement of the SICD system involves several detailed steps:

Step 1: An incision is made in the subxiphoid space, allowing access to the substernal area. Blunt dissection is performed through the diaphragmatic attachments to reach the substernal space.
Step 2: A peel-away sheath is placed over a tunneling tool. Under fluoroscopic guidance, the tunneling tool is advanced from the substernal space medially to the left lateral border of the sternum, continuing until it reaches the top of the cardiac silhouette.
Step 3: The sheath is advanced past the end of the tunneling tool, which is then removed. The electrode is advanced through the sheath to the desired location.
Step 4: An incision is made in the left midaxillary region, where a subcutaneous pocket is created over the lateral rib cage for the ICD device generator.
Step 5: A subcutaneous tunnel is created from the pocket to the subxiphoid space. The electrode is threaded through this tunnel and connected to the pulse generator.
Step 6: The device is programmed and tested to ensure proper functionality. Adjustments to the electrode location may be made if necessary, and the sheath is subsequently removed.
Step 7: Finally, the incisions in the subxiphoid and left axillary regions are closed to complete the procedure.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate complications and ensuring the proper functioning of the SICD system. Patients may be advised on activity restrictions and follow-up appointments for device checks and programming adjustments. Recovery time may vary, but patients are typically monitored closely to assess for any signs of infection or device malfunction. Proper wound care instructions will be provided to facilitate healing at the incision sites.

Short Descr	INSJ/RPLCMT ICDS SS ELTRD
Medium Descr	INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE
Long Descr	Insertion or replacement of implantable cardioverter-defibrillator system with substernal electrode(s), including all imaging guidance and electrophysiological evaluation (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters), when performed
Status Code	Carriers Price the Code
Global Days	YYY - Carrier Determines Whether Global Concept Applies
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Hospital Part B services paid through a comprehensive APC
Berenson-Eggers TOS (BETOS)	none
MUE	1

GC	This service has been performed in part by a resident under the direction of a teaching physician
Q0	Investigational clinical service provided in a clinical research study that is in an approved clinical research study