CPT® Code 0573T

1. Indications

The removal of a substernal implantable defibrillator electrode, as described by CPT® Code 0573T, is indicated in specific clinical scenarios. These may include:

• Device Replacement Removal may be necessary when the existing electrode is being replaced due to malfunction or upgrade of the SICD system.
• Complications The procedure may be indicated if there are complications associated with the electrode, such as infection, lead fracture, or inappropriate sensing or pacing.
• Patient Condition Change If a patient's clinical condition changes, necessitating the discontinuation of the SICD system, the electrode may need to be removed.

2. Procedure

The procedure for the removal of the substernal implantable defibrillator electrode involves several key steps, which are detailed as follows:

• Step 1: Incision and Access An incision is made in the subxiphoid space, which is located just below the sternum. The surgeon performs blunt dissection through the diaphragmatic attachments to gain access to the substernal space where the electrode is located.
• Step 2: Tunneling Tool Placement A peel-away sheath is placed over a tunneling tool. Under fluoroscopic guidance, the tool is advanced from the substernal space medially to the left lateral border of the sternum, reaching the top of the cardiac silhouette.
• Step 3: Electrode Advancement Once the tunneling tool is in position, the sheath is advanced past the end of the tool, which is then removed. The electrode is then advanced through the sheath to the desired location for removal.
• Step 4: Closure of Incisions After the electrode has been successfully removed, the subxiphoid incision is closed. If there was a left midaxillary incision made for the ICD device generator, that incision is also closed appropriately.

3. Post-Procedure

Post-procedure care following the removal of the substernal implantable defibrillator electrode includes monitoring the patient for any signs of complications such as infection or bleeding at the incision sites. Patients may be advised to limit physical activity for a specified period to allow for proper healing. Follow-up appointments may be scheduled to assess the recovery process and ensure that the patient is not experiencing any adverse effects from the procedure. Documentation of the procedure and any findings during the removal is essential for medical records and future reference.