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The procedure described by CPT® Code 33238 involves the surgical removal of one or more permanent transvenous electrodes through a thoracotomy. Transvenous electrodes, also known as endocardial electrodes, are typically used in cardiac pacing and defibrillation. These electrodes may need to be extracted due to various reasons, including damage or malfunction of the lead(s), infection at the site of the generator or lead(s), or complications such as interference with blood flow caused by the lead(s). A thoracotomy is indicated when the electrodes cannot be safely removed using a transvenous approach, which may occur in cases where there is dense scar tissue and adhesions or when the electrodes are deeply embedded within the myocardium, the heart muscle itself. During the procedure, a surgical incision is made in the chest over the pacemaker generator, allowing access to disconnect the lead. The heart is then exposed through a median sternotomy, which involves opening the chest cavity to provide a clear view of the heart. In certain cases, if cardiopulmonary bypass is necessary, the aorta is cannulated, followed by the superior and inferior vena cava to facilitate the procedure. The removal of the electrodes may involve incising the right atrium to access an atrial electrode or making an incision in the right ventricle for a ventricular electrode. The surgeon carefully dissects the electrode free from any adhesive scar tissue before removal. After the electrodes are extracted, the heart wall incisions are closed, and chest tubes may be placed as needed to ensure proper drainage. Finally, the chest is closed to complete the procedure.
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The procedure described by CPT® Code 33238 is indicated for the removal of permanent transvenous electrodes in specific clinical scenarios. These indications include:
The procedure for the removal of permanent transvenous electrodes by thoracotomy involves several critical steps:
Post-procedure care following the removal of permanent transvenous electrodes by thoracotomy includes monitoring the patient for any signs of complications, such as infection or bleeding. Patients may require pain management and will be observed for cardiac function to ensure that the heart is responding appropriately after the removal of the electrodes. The placement of chest tubes will be monitored to ensure proper drainage and to prevent any accumulation of fluid in the thoracic cavity. Follow-up appointments will be necessary to assess the recovery process and to address any concerns that may arise during the healing period.
| Short Descr | REMOVE ELECTRODE/THORACOTOMY | Medium Descr | RMVL PRM TRANSVENOUS ELECTRODE THORACOTOMY | Long Descr | Removal of permanent transvenous electrode(s) by thoracotomy | 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). | 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study |
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| 1994-01-01 | Added | First appearance in code book in 1994. |
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