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CPT®
0574T

CPT® Code 0574T

Official Description

Repositioning of previously implanted substernal implantable defibrillator-pacing electrode

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 0574T refers to the procedure of repositioning a previously implanted substernal implantable defibrillator-pacing electrode. This procedure is specifically associated with a subcutaneous implantable cardioverter-defibrillator (SICD) system, which is designed to treat ventricular arrhythmias in patients who require an implantable cardioverter-defibrillator (ICD) but have limited access to the venous system. Unlike traditional ICDs that are placed within the vascular system and may come into contact with the heart, the SICD system operates subcutaneously, thereby avoiding these complications. The repositioning process involves making an incision in the subxiphoid area, allowing for access to the substernal space where the electrode is located. The procedure is performed under fluoroscopic guidance to ensure accurate placement of the electrode, which is then connected to the ICD device generator that is housed in a subcutaneous pocket created in the left midaxillary region. This method not only enhances the safety of the procedure but also provides an effective means of managing life-threatening arrhythmias in patients with anatomical challenges that preclude traditional ICD placement.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure associated with CPT® Code 0574T is indicated for patients who require an implantable cardioverter-defibrillator (ICD) but have limited venous access. This situation often arises in individuals with anatomical variations or previous medical interventions that complicate traditional ICD placement. The SICD system, which utilizes substernal electrode(s), is particularly beneficial for treating ventricular arrhythmias in these patients, as it does not enter the vascular system or come into contact with the beating heart.

  • Limited Venous Access Patients who have anatomical challenges or prior interventions that restrict access to the venous system for traditional ICD placement.
  • Ventricular Arrhythmias Individuals experiencing life-threatening ventricular arrhythmias who require an effective means of cardiac rhythm management.

2. Procedure

The procedure for repositioning a previously implanted substernal implantable defibrillator-pacing electrode involves several detailed steps to ensure proper placement and functionality of the device.

  • Step 1: Incision and Access An incision is made in the subxiphoid space, which allows the surgeon to perform blunt dissection through the diaphragmatic attachments. This step is crucial for gaining 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. This precise navigation is essential for the correct positioning of the electrode.
  • Step 3: Electrode Advancement Once the tunneling tool is in place, 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, ensuring it is optimally positioned for effective cardiac pacing and defibrillation.
  • Step 4: Creation of Subcutaneous Pocket An incision is made in the left midaxillary region, where a subcutaneous pocket is created over the lateral rib cage to accommodate the ICD device generator. This pocket is essential for housing the generator securely.
  • Step 5: Subcutaneous Tunnel Creation 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, establishing the necessary electrical connection for the device to function.
  • Step 6: Device Programming and Testing The device is programmed and tested to ensure it operates correctly. Adjustments to the electrode location may be made if necessary to optimize performance.
  • Step 7: Closure Finally, the subxiphoid and left axillary incisions are closed, completing the procedure.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications related to the incision sites and the functionality of the newly positioned electrode. Patients may be advised on activity restrictions to ensure proper healing and to avoid dislodging the electrode. Follow-up appointments are typically scheduled to assess the device's performance and to make any necessary adjustments. It is essential to provide the patient with instructions regarding signs of infection or other complications that may arise after the procedure.
Short Descr REPOS PREV SS IMPL DFB ELTRD
Medium Descr REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD
Long Descr Repositioning of previously implanted substernal implantable defibrillator-pacing electrode
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 T-Packaged Codes
Berenson-Eggers TOS (BETOS) none
MUE 1
Date
Action
Notes
2021-01-01 Changed First appearance of AMA Guideline changes in code book.
2020-07-01 Changed AMA Guidelines changed.
2020-01-01 Added Code added.
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