CPT® Code 0614T

Official Description

Removal and replacement of substernal implantable defibrillator pulse generator

Common Language Description

The procedure described by CPT® Code 0614T involves the removal and replacement of a substernal implantable defibrillator pulse generator. An implantable cardioverter-defibrillator (ICD) is a medical device designed to monitor and treat life-threatening heart rhythms. The substernal ICD is specifically positioned with electrode(s) placed beneath the sternum, while the pulse generator, which is responsible for delivering electrical shocks to restore normal heart rhythm, is implanted in a subcutaneous pocket located on the left side of the chest, near the midaxillary line. This configuration allows the device to provide essential functions such as pacing to prevent tachycardia and delivering low-energy cardioversion or defibrillating shocks to address ventricular fibrillation. The pulse generator itself is a compact metal enclosure that houses electric circuits and a battery, typically lithium-based, which has a lifespan of approximately 5 to 10 years. However, replacement of the pulse generator may be necessary prior to the battery reaching its end of life if the device exhibits malfunctioning behavior or if there is an infection at the implantation site. The procedure is generally performed under sedation with local anesthesia, ensuring patient comfort while allowing the physician to access the device through an incision made over the generator. This detailed process ensures that the ICD continues to function effectively in monitoring and treating cardiac arrhythmias.

1. Indications

The removal and replacement of a substernal implantable defibrillator pulse generator is indicated in the following situations:

Device Malfunction Replacement may be necessary if the pulse generator is not functioning correctly, which could compromise its ability to monitor and treat arrhythmias effectively.
Infection If there is an infection at the site of the device, it may necessitate the removal of the existing generator to prevent further complications and to allow for appropriate treatment of the infection.

2. Procedure

The procedure for the removal and replacement of a substernal implantable defibrillator pulse generator involves several critical steps:

Step 1: Anesthesia Administration The procedure begins with the administration of sedation and local anesthesia to ensure the patient is comfortable and pain-free during the operation.
Step 2: Incision A surgical incision is made over the existing pulse generator, allowing access to the subcutaneous pocket where the device is located. This incision is carefully placed to minimize tissue damage and facilitate easy access.
Step 3: Accessing the Device The surgeon meticulously dissects through the skin and surrounding tissue to reach the pulse generator. Once accessed, the generator is disconnected from the leads that connect it to the implanted electrodes.
Step 4: Removal of the Old Generator After disconnecting the leads, the old pulse generator is carefully removed from the subcutaneous pocket. This step requires precision to avoid damaging the surrounding tissues.
Step 5: Insertion of the New Generator A new pulse generator is then placed into the same pocket. The new device is reattached to the existing leads, ensuring that all connections are secure and functioning properly.
Step 6: Testing the Device Once the new generator is in place, it is tested to confirm that it is operating correctly and is capable of delivering the necessary electrical impulses for pacing and defibrillation.
Step 7: Closure Finally, the incision site is closed using appropriate suturing techniques, and the area is dressed to promote healing.

3. Post-Procedure

After the removal and replacement of the substernal implantable defibrillator pulse generator, patients are typically monitored for any immediate complications. Post-procedure care may include instructions on activity restrictions, wound care, and signs of infection to watch for at the incision site. Patients may also be advised to follow up with their healthcare provider to ensure the new device is functioning correctly and to assess the overall recovery process. The expected recovery time can vary, but patients are generally encouraged to resume normal activities gradually, following their physician's guidance.

Short Descr	RMVL&RPLCMT SS IMPL DFB PG
Medium Descr	RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG
Long Descr	Removal and replacement of substernal implantable defibrillator pulse generator
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
ASC Payment Indicator	Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate.
Berenson-Eggers TOS (BETOS)	none
MUE	1