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Official Description

Removal of subcutaneous implantable defibrillator electrode

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 33272 involves the removal of a subcutaneous implantable defibrillator electrode, which is a specialized medical device used in cardiac care. This electrode is designed as a multi-lumen polymeric tube lead wire that incorporates both sensing electrodes and a defibrillator shocking coil. The primary purpose of this procedure is to safely extract the electrode from the body, which may be necessary due to device malfunction, patient complications, or as part of a planned device replacement. The removal process requires precise identification of anatomical landmarks on the left chest, specifically at the sixth rib and along the left sternal border, to ensure accurate incision placement. The procedure entails making incisions at designated sites, carefully dissecting the electrode from the surrounding subcutaneous tissue, and ultimately disconnecting and removing the electrode in two sections. This meticulous approach is essential to minimize trauma to the surrounding tissues and ensure a successful outcome.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The removal of a subcutaneous implantable defibrillator electrode, as described by CPT® Code 33272, is indicated in specific clinical scenarios. These may include:

  • Device Malfunction The electrode may need to be removed if it is not functioning correctly, which could compromise the effectiveness of the defibrillator.
  • Patient Complications Complications such as infection, lead fracture, or other adverse reactions may necessitate the removal of the electrode to ensure patient safety and health.
  • Device Replacement The procedure may be indicated as part of a planned replacement of the defibrillator system, where the old electrode must be removed to accommodate a new device.

2. Procedure

The procedure for the removal of a subcutaneous implantable defibrillator electrode involves several critical steps to ensure safety and effectiveness.

  • Step 1: Identification of Anatomical Landmarks The first step involves identifying the previous anatomical landmarks on the left chest. This includes locating the sixth rib between the mid-axillary and anterior axillary lines, as well as the left sternal border at the second intercostal space for distal lead placement and the xiphoid process for proximal lead placement.
  • Step 2: Making Incisions Once the landmarks are identified, skin incisions are made at the distal site, proximal site, and the left lateral chest site. These incisions are crucial for accessing the electrode and minimizing tissue damage during the removal process.
  • Step 3: Identifying the Electrode After making the incisions, the electrode is carefully identified. If a pulse generator is present, it is programmed off to ensure safety during the disconnection process.
  • Step 4: Disconnecting the Electrode The electrode is then disconnected from the pulse generator. A non-traumatic tunneling tool may be utilized to gently free the electrode from the surrounding subcutaneous tissue, facilitating its removal.
  • Step 5: Dissecting the Electrode Once the electrode is adequately freed from the tissue, it is disconnected at the proximal site. The securing sutures at the distal and lateral chest sites are then cut to allow for complete removal.
  • Step 6: Removing the Electrode The electrode is removed in two sections to minimize trauma and ensure a smooth extraction process.
  • Step 7: Closing Incisions Finally, the incisions made during the procedure are closed with sutures, ensuring proper healing and minimizing the risk of complications.

3. Post-Procedure

Post-procedure care following the removal of a subcutaneous implantable defibrillator electrode is essential for optimal recovery. Patients are typically monitored for any signs of complications, such as infection or excessive bleeding, at the incision sites. Pain management may be provided as needed, and patients are advised on wound care to promote healing. Follow-up appointments may be scheduled to assess the recovery process and to determine if further interventions or device replacements are necessary. It is crucial for healthcare providers to educate patients on signs of complications that should prompt immediate medical attention.

Short Descr RMVL OF SUBQ DEFIBRILLATOR
Medium Descr RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE
Long Descr Removal of subcutaneous implantable defibrillator electrode
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 T-Packaged Codes
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P2E - Major procedure, cardiovascular-Pacemaker insertion
MUE 1
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).
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.)
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
GC This service has been performed in part by a resident under the direction of a teaching physician
GW Service not related to the hospice patient's terminal condition
GZ Item or service expected to be denied as not reasonable and necessary
Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study
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2015-01-01 Added Added
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