CPT® Code 0428T

Code Deleted. See 33279, 33280.

Official Description

Removal of neurostimulator system for treatment of central sleep apnea; pulse generator only

Common Language Description

The procedure described by CPT® Code 0428T involves the removal of a neurostimulator system specifically designed for the treatment of central sleep apnea. Central sleep apnea is a condition characterized by the temporary cessation of breathing due to the brain's failure to signal the muscles responsible for respiration. This condition can be triggered by various factors, including strokes, anatomical issues affecting the neck or brainstem, morbid obesity, and the use of narcotic medications. The neurostimulator system itself comprises an implantable pulse generator, a stimulation lead that interfaces with the hypoglossal nerve (the twelfth cranial nerve), and a pressure sensing lead that is positioned within the chest. The focus of this procedure is solely on the removal of the pulse generator, which entails a surgical approach where an incision is made in the chest wall to access the device located in a pocket just above the pectoralis major muscle. The procedure requires careful disconnection of the pressure sensing and stimulation wires from the pulse generator before the device is extracted and the incision is subsequently closed. This procedure is critical for patients who no longer require the neurostimulator system or who may be transitioning to a different treatment modality.

1. Indications

The procedure is indicated for patients who have a neurostimulator system implanted for the treatment of central sleep apnea and require the removal of the pulse generator. This may be due to various reasons, including:

Device Malfunction: The pulse generator may be malfunctioning or no longer effective in managing the symptoms of central sleep apnea.
Patient Preference: The patient may choose to discontinue the use of the neurostimulator system for personal or medical reasons.
Transition to Alternative Treatments: The patient may be transitioning to other therapeutic options for managing central sleep apnea.
Complications: There may be complications associated with the device that necessitate its removal.

2. Procedure

The procedure for the removal of the neurostimulator system's pulse generator involves several key steps:

Step 1: The surgical team begins by determining the precise location of the pulse generator, which is typically situated in a pocket beneath the pectoralis major muscle in the chest wall.
Step 2: An incision is made in the chest wall to access the device. This incision is carefully placed to minimize tissue damage and facilitate access to the pulse generator.
Step 3: Once the incision is made, the pulse generator is exposed, and the surgical team disconnects the pressure sensing lead and stimulation lead from the pulse generator. This step is crucial to ensure that the device can be safely removed without causing damage to the surrounding tissues.
Step 4: After the leads are disconnected, the pulse generator is carefully extracted from its pocket. The removal process must be conducted with precision to avoid complications.
Step 5: Following the removal of the pulse generator, the incision in the chest wall is closed using appropriate suturing techniques to promote healing and minimize scarring.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate complications related to the surgery. Patients may experience some discomfort at the incision site, which can be managed with appropriate pain relief measures. It is essential to provide instructions for wound care to prevent infection and ensure proper healing. Follow-up appointments may be scheduled to assess the recovery process and address any concerns the patient may have. Additionally, the healthcare provider may discuss alternative treatment options for managing central sleep apnea if necessary.

Short Descr	RMVL NSTIM APNEA PLS GEN
Medium Descr	REMOVAL NSTIM SYSTEM SLEEP APNEA PLS GENERATOR
Long Descr	Removal of neurostimulator system for treatment of central sleep apnea; pulse generator only
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No 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)	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
Berenson-Eggers TOS (BETOS)	P5E - Ambulatory procedures - other
MUE	Not applicable/unspecified.

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.