© Copyright 2025 American Medical Association. All rights reserved.
The procedure described by CPT® Code 33270 involves the insertion or replacement of a permanent subcutaneous implantable defibrillator system. This system is designed to monitor and treat life-threatening arrhythmias, such as ventricular tachycardia or ventricular fibrillation. The device consists of a pulse generator and a lead wire that contains sensing electrodes and a shocking coil. The electrodes are responsible for capturing the cardiac rhythm and transmitting this information to the pulse generator. Upon detecting an arrhythmia, the pulse generator activates the shocking coil to deliver an electrical shock, effectively terminating the arrhythmia and restoring normal heart rhythm. The procedure requires precise anatomical identification and surgical techniques to ensure proper placement of the device and its components, which are critical for the device's functionality and the patient's safety. The process includes evaluating the defibrillation threshold, inducing arrhythmias for testing, and programming the device to optimize its sensing and therapeutic parameters, ensuring that it responds appropriately to the patient's cardiac events.
© Copyright 2025 Coding Ahead. All rights reserved.
The insertion or replacement of a permanent subcutaneous implantable defibrillator system is indicated for patients who are at high risk for life-threatening arrhythmias. This includes individuals with a history of ventricular tachycardia or ventricular fibrillation, those with structural heart disease, or patients who have experienced unexplained syncope. The procedure is also indicated for patients who have previously received an implantable cardioverter-defibrillator (ICD) but require a replacement due to device malfunction or battery depletion.
The procedure for the insertion or replacement of a permanent subcutaneous implantable defibrillator system involves several critical steps to ensure proper placement and functionality of the device. First, anatomical landmarks are identified and marked on the patient's anterior and left lateral chest to guide the surgical incisions. An incision is made on the left lateral side, specifically between the fifth and sixth intercostal space along the mid-axillary line, to create a subcutaneous pocket that will accommodate the pulse generator. Next, the surgeon locates the tip of the xiphoid process at the base of the sternum and makes an incision along the left sternal border at the second intercostal space for the distal lead placement. A second incision is made at the xiphoid process for the proximal lead placement. The lead wire, which contains the sensing electrodes and shocking coil, is then tunneled just beneath the skin along the rib line from the xiphoid to the subcutaneous pouch in the left chest. To complete the distal insertion, a small incision is made in the mid-sternum, allowing the distal tip of the electrode to be tunneled from the xiphoid to the superior sternum. This positioning places the distal sensing electrode adjacent to the manubriosternal junction and the proximal sensing electrode next to the xiphoid process, with the shocking coil situated between these two points. Once the lead wire is in place, it is suture anchored to the patient's fascia at the distal site to secure it. The electrode is then connected to the pulse generator, which is programmed externally. The patient is monitored as an arrhythmia is induced to evaluate the device's response in terminating the arrhythmia. During this phase, defibrillation threshold evaluation and potential reprogramming of sensing or therapeutic levels may be performed to ensure optimal device performance. After confirming that the unit is functioning correctly, the pulse generator is placed within the subcutaneous pocket and secured to the patient's fascia, followed by closure of the incisions.
After the procedure, the patient will be monitored for any immediate complications and to ensure the defibrillator is functioning correctly. Post-procedure care includes monitoring the surgical site for signs of infection, ensuring proper healing of the incisions, and assessing the patient's overall recovery. Patients may be advised on activity restrictions to allow for proper healing and to avoid dislodging the device. Follow-up appointments will be necessary to evaluate the device's performance, adjust settings if needed, and conduct routine checks to ensure the system is operating optimally. Patients should also be educated on recognizing symptoms that may indicate device malfunction or complications, such as unusual pain, swelling, or changes in heart rhythm.
| Short Descr | INS/REP SUBQ DEFIBRILLATOR | Medium Descr | INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD | Long Descr | Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed | 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 | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2E - Major procedure, cardiovascular-Pacemaker insertion | MUE | 1 |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | 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). | 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). | 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). | 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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.) | AO | Alternate payment method declined by provider of service | 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 | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GZ | Item or service expected to be denied as not reasonable and necessary | KX | Requirements specified in the medical policy have been met | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2022-01-01 | Added | First appearance in codebook. |
| 2015-01-01 | Added | Added |
Get instant expert-level medical coding assistance.