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The procedure described by CPT® Code 33203 involves the insertion of epicardial electrode(s) through an endoscopic approach, specifically utilizing techniques such as thoracoscopy or pericardioscopy. Epicardial electrodes, also referred to as leads, are critical components used in cardiac pacing and defibrillation. These electrodes are strategically placed on the outer surface of the heart muscle to facilitate electrical stimulation, which is essential for managing various cardiac conditions. Unlike traditional methods that require an open chest incision, the endoscopic approach minimizes trauma to the chest wall and surrounding tissues, leading to potentially quicker recovery times and reduced postoperative complications. The procedure is performed with the chest cavity opened to expose the heart, allowing for precise placement of the electrodes in designated areas of the heart muscle. The choice of electrode placement depends on the type of device being utilized, whether it is a single or dual chamber permanent pacemaker or a pacing cardioverter defibrillator. This code specifically pertains to the insertion of the epicardial leads only, excluding the generator component of the device, which is typically implanted separately. The endoscopic technique represents a significant advancement in cardiac procedures, offering a less invasive option for patients requiring epicardial pacing solutions.
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The insertion of epicardial electrode(s) using an endoscopic approach is indicated for patients who require cardiac pacing or defibrillation due to various cardiac conditions. These may include:
The procedure for the insertion of epicardial electrode(s) via an endoscopic approach involves several critical steps:
Post-procedure care involves monitoring the patient for any immediate complications, such as bleeding or infection at the incision sites. Patients are typically observed in a recovery area until they are stable. Instructions regarding activity restrictions, wound care, and follow-up appointments are provided to ensure proper healing and device function. Patients may also undergo further testing to assess the performance of the epicardial leads and the connected device. It is essential to educate patients about signs of potential complications, such as unusual pain, swelling, or changes in heart rhythm, and to encourage them to report any concerns promptly.
| Short Descr | INSERT EPICARD ELTRD ENDO | Medium Descr | INSERTION EPICARDIAL ELECTRODE ENDOSCOPIC | Long Descr | Insertion of epicardial electrode(s); endoscopic approach (eg, thoracoscopy, pericardioscopy) | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard 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) | 1 - Statutory 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 | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 48 - Insertion, revision, replacement, removal of cardiac pacemaker or cardioverter/defibrillator |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) |
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| 2011-01-01 | Changed | Short description changed. |
| 2007-01-01 | Added | First appearance in code book in 2007. |
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