CPT® Code 0861T

1. Indications

The removal of the pulse generator for a wireless cardiac stimulator for left ventricular pacing, as described by CPT® Code 0861T, is indicated in specific clinical situations. These indications may include:

• Infection of the existing battery pocket - This condition necessitates the removal of the pulse generator to prevent further complications and to allow for appropriate treatment of the infection.
• Device malfunction - If the wireless cardiac stimulator is not functioning as intended, removal may be required to address the issue.
• Patient intolerance - In cases where the patient experiences adverse effects or discomfort related to the device, removal may be warranted.
• Need for device upgrade or replacement - If a newer model or technology becomes available, the existing device may need to be removed to facilitate the implantation of an updated system.

2. Procedure

The procedure for the removal of the pulse generator for the wireless cardiac stimulator involves several critical steps, each designed to ensure the safe extraction of the device components. The steps are as follows:

• Incision over the previous implant scar site - The surgeon begins by making an incision along the mid-axillary line, lateral to the parasternal border, specifically in the area of the 4th to 6th intercostal spaces. This incision allows access to the subcutaneous pocket where the transmitter is located.
• Accessing and removing the transmitter - Once the incision is made, the surgeon carefully dissects through the tissue to access the transmitter. The transmitter is then gently removed from its pocket, taking care to avoid damage to surrounding structures.
• Second incision for battery access - A second incision is made over a different site to the left of the first incision. This incision provides access to the subcutaneous pocket where the battery is housed.
• Removing the battery - Similar to the removal of the transmitter, the surgeon carefully accesses the battery and removes it from its pocket, ensuring that the procedure is performed with precision.
• Disconnecting the transmitter cable - A torque wrench is utilized to disconnect the transmitter cable from the battery. This step is crucial to ensure that the components are safely separated without causing damage.
• Closing the wounds - After both components have been successfully removed, the surgical sites are closed with sutures, ensuring proper healing and minimizing the risk of complications.

3. Post-Procedure

Post-procedure care following the removal of the pulse generator for the wireless cardiac stimulator involves monitoring the patient for any signs of complications, such as infection or excessive bleeding. Patients may be advised to keep the incision sites clean and dry, and to follow specific instructions regarding activity restrictions to promote healing. Follow-up appointments are typically scheduled to assess the surgical sites and to determine if any further interventions are necessary. Additionally, patients may require education on recognizing signs of complications and when to seek medical attention.