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The procedure described by CPT® Code 33237 involves the removal of a permanent epicardial pacemaker and its associated electrodes through a surgical approach known as thoracotomy. This specific code is utilized when a dual lead system is being removed, which means that the pacemaker has two electrodes, one typically placed in the atrium and the other in the ventricle of the heart. The process begins with the opening of the pacemaker pocket, where the epicardial electrode, which is the lead or wire connected to the pacemaker generator, is disconnected. Following this, the generator itself is removed, and the pocket is subsequently closed. The surgical approach to access the heart can vary, including median sternotomy, subxiphoid, or subcostal techniques, all of which involve opening the chest to expose the heart. Once the heart is accessible, the epicardial pacemaker electrode is carefully dissected 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 procedure is critical for patients who require the removal of a dual lead epicardial pacemaker due to various clinical reasons, such as device malfunction or the need for replacement.
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The removal of a permanent epicardial pacemaker and electrodes by thoracotomy, as described by CPT® Code 33237, is indicated in specific clinical scenarios. These may include:
The procedure for the removal of a permanent epicardial pacemaker and electrodes by thoracotomy involves several critical steps:
After the procedure, patients are typically monitored for any signs of complications, such as infection or bleeding. The placement of chest tubes may require careful management to ensure proper drainage and prevent pneumothorax. Patients can expect a recovery period that may vary based on individual health factors and the complexity of the surgery. Follow-up appointments are essential to assess the surgical site, remove any sutures if necessary, and evaluate the patient's overall cardiac function post-removal of the pacemaker system.
| Short Descr | REMOVE ELECTRODE/THORACOTOMY | Medium Descr | RMVL PRM EPICAR PM&ELTRDS THORCOM DUAL LEAD SY | Long Descr | Removal of permanent epicardial pacemaker and electrodes by thoracotomy; dual lead system | 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient 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). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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.) | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code 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 |
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| 2013-01-01 | Changed | Medium Descriptor changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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