CPT® Code 0862T

1. Indications

The relocation of the pulse generator for a wireless cardiac stimulator is indicated in specific clinical scenarios where the existing device may no longer function optimally or where complications have arisen. The following conditions may warrant this procedure:

• Erosion of the subcutaneous pocket - This occurs when the tissue surrounding the implanted device deteriorates, potentially exposing the device and necessitating relocation to a new site.
• Anatomical problems - Patients may have unique anatomical challenges that complicate the placement of conventional pacing leads, making the wireless option more suitable.
• Dislodgement of the lead - If the lead has become dislodged, it may not provide adequate stimulation, prompting the need for a relocation of the pulse generator to ensure effective pacing.
• Poor ventricular response - In cases where the conventional pacing is ineffective, the wireless LV pacing device may be relocated to improve cardiac resynchronization therapy outcomes.

2. Procedure

The procedure for relocating the pulse generator for a wireless cardiac stimulator involves several critical steps to ensure the device is properly repositioned and functions effectively. The following steps outline the process:

• Step 1: Incision and Access - An incision is made at the previous implant site to access the existing subcutaneous pocket where the pulse generator is located. This step is crucial for safely retrieving the device.
• Step 2: Removal of the Battery - Once the pocket is opened, the battery component of the wireless cardiac stimulator is carefully removed. This step is essential to prevent any potential damage to the device during the relocation process.
• Step 3: Disconnection of the Transmitter Cable - The transmitter cable, which connects the battery to the pacing system, is disconnected. This allows for the complete removal of the device from its original location.
• Step 4: Creation of a New Pocket - A new subcutaneous pocket is created at a different anatomical site. This new location is selected based on the patient's specific needs and any previous complications encountered.
• Step 5: Reconnection of the Battery - The battery is reconnected to the transmitter cable and secured in place within the newly created pocket. This step ensures that the device is properly positioned for optimal function.
• Step 6: Testing and Programming - After the device is secured, it is tested for functionality to ensure it operates correctly. Any necessary programming adjustments are made at this stage to optimize the pacing settings for the patient.

3. Post-Procedure

Following the relocation of the pulse generator, patients may require specific post-procedure care to ensure proper healing and device functionality. Monitoring for any signs of infection at the incision site is essential, as well as ensuring that the device is functioning as intended. Patients may be advised on activity restrictions to allow for adequate healing of the new pocket site. Follow-up appointments will be necessary to assess the device's performance and make any further programming adjustments if needed. Overall, the post-procedure phase is critical for ensuring the long-term success of the wireless cardiac pacing system.