CPT® Code 0429T

Code Deleted. See 33279, 33280.

Official Description

Removal of neurostimulator system for treatment of central sleep apnea; sensing lead only

Common Language Description

The procedure described by CPT® Code 0429T involves the removal of a neurostimulator system specifically 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 stroke, anatomical issues affecting the neck or brainstem, morbid obesity, and the use of narcotic medications. The neurostimulator system utilized in this treatment 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 in the chest. During the removal procedure, the focus is on extracting the sensing lead only. The process begins with the identification of the pulse generator's location, followed by an incision made in the chest wall to access the device, which is situated in a pocket just above the pectoralis major muscle. The procedure entails disconnecting the pressure sensing lead from the pulse generator, utilizing a subcutaneous tunneling tool to carefully free the lead from its anatomical position between the external and internal intercostal muscles, and subsequently removing it. After the lead is successfully extracted, the incision is closed. This procedure is critical for patients who may no longer require the neurostimulator system or who are experiencing complications related to the device.

1. Indications

The procedure associated with CPT® Code 0429T is indicated for patients diagnosed with central sleep apnea, which is characterized by the brain's intermittent failure to signal the muscles that control breathing. This condition may arise from various underlying factors, including:

Stroke: A cerebrovascular accident that can disrupt normal brain function, potentially affecting the respiratory centers.
Conditions affecting the neck or brainstem: Anatomical or pathological issues in these areas can interfere with the neural pathways responsible for breathing regulation.
Morbid obesity: Excess body weight can contribute to respiratory difficulties and may necessitate the use of a neurostimulator for treatment.
Narcotic use: The use of narcotic medications can depress the central nervous system, leading to episodes of central sleep apnea.

2. Procedure

The procedure for the removal of the pressure sensing lead from the neurostimulator system involves several critical steps, which are detailed as follows:

Step 1: The initial step requires the identification of the pulse generator's position within the chest. This is crucial for ensuring that the subsequent incision is made in the correct location.
Step 2: An incision is then made in the chest wall to expose the pulse generator. This incision is typically located in the area where the device is implanted, allowing for direct access to the neurostimulator system.
Step 3: Once the pulse generator is exposed, the pressure sensing lead is carefully disconnected from the device. This step is essential to ensure that the lead can be removed without damaging the pulse generator or surrounding tissues.
Step 4: A subcutaneous tunneling tool is utilized to free the pressure sensing lead from its anatomical position. This tool aids in navigating the lead's path between the external and internal intercostal muscles, facilitating its removal.
Step 5: After the pressure sensing lead is successfully freed, it is removed from the body. This completes the primary objective of the procedure.
Step 6: Finally, the incision made in the chest wall is closed, ensuring proper healing and minimizing the risk of infection.

3. Post-Procedure

Post-procedure care following the removal of the pressure sensing lead involves monitoring the patient for any signs of complications, such as infection or excessive bleeding at the incision site. Patients may be advised to avoid strenuous activities for a specified period to promote healing. Follow-up appointments may be scheduled to assess the recovery process and ensure that the patient is not experiencing any adverse effects related to the removal of the neurostimulator system. Additionally, patients should be educated on signs and symptoms that warrant immediate medical attention, such as increased pain, swelling, or discharge from the incision site.

Short Descr	RMVL NSTIM APNEA SEN LD
Medium Descr	REMOVAL NSTIM SYSTEM SLEEP APNEA SENSING LEAD
Long Descr	Removal of neurostimulator system for treatment of central sleep apnea; sensing lead 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.

80	Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
Q0	Investigational clinical service provided in a clinical research study that is in an approved clinical research study