© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 33236 refers to the surgical procedure for the removal of a permanent epicardial pacemaker and its electrodes through a thoracotomy approach, specifically for a single lead system, which can be either atrial or ventricular. This procedure involves several critical steps, beginning with the opening of the pacemaker pocket where the epicardial electrode, also known as the lead or wire, is disconnected from the pacemaker generator. Following this, the generator itself is removed, and the pocket is subsequently closed to prevent complications. The thoracotomy, which is a surgical incision into the chest wall, can be performed using various approaches such as median sternotomy, subxiphoid, or subcostal, allowing the physician to gain access to the heart. Once the chest is opened, the heart is carefully exposed, and the epicardial pacemaker electrode is meticulously dissected free from any surrounding tissue that may have adhered to it along its path through the thorax and at its point of attachment to the pericardium. After the electrode is successfully removed, chest tubes may be placed as necessary to facilitate drainage, and the chest is then closed. This code is specifically applicable when a single lead system is being removed, while a different code, CPT® 33237, is designated for the removal of a dual lead system.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure associated with CPT® Code 33236 is indicated for patients who have a permanent epicardial pacemaker that requires removal. This may be due to various reasons, including:
The procedure for the removal of a permanent epicardial pacemaker and electrodes by thoracotomy involves several detailed steps:
Post-procedure care following the removal of a permanent epicardial pacemaker involves monitoring the patient for any signs of complications, such as infection or bleeding. The placement of chest tubes, if necessary, will aid in the drainage of any fluid that may accumulate in the thoracic cavity. Patients are typically observed in a recovery area until they are stable, and pain management is provided as needed. Follow-up appointments will be necessary to assess the surgical site and ensure proper healing. The physician will also evaluate the patient's overall condition and determine if any further interventions or monitoring are required.
| Short Descr | REMOVE ELECTRODE/THORACOTOMY | Medium Descr | RMVL PRM EPICAR PM&ELTRDS THORCOM 1 LEAD SYS | Long Descr | Removal of permanent epicardial pacemaker and electrodes by thoracotomy; single lead system, atrial or ventricular | 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) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | 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) | P2E - Major procedure, cardiovascular-Pacemaker insertion | MUE | 1 | CCS Clinical Classification | 48 - Insertion, revision, replacement, removal of cardiac pacemaker or cardioverter/defibrillator |
| 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). | 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. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 1994-01-01 | Added | First appearance in code book in 1994. |
Get instant expert-level medical coding assistance.