CPT® Code 0452T

Official Description

Insertion or replacement of a permanently implantable aortic counterpulsation ventricular assist system, endovascular approach, and programming of sensing and therapeutic parameters; aortic counterpulsation device and vascular hemostatic seal

Common Language Description

The procedure described by CPT® Code 0452T involves the insertion or replacement of a permanently implantable aortic counterpulsation ventricular assist system using an endovascular approach. This advanced medical intervention is designed to support patients with severe cardiac conditions, particularly those experiencing acute cardiogenic shock or end-stage chronic heart failure. The aortic counterpulsation device consists of a pneumatic pump that operates in conjunction with a console, which drives the pump using pressurized air. This system is synchronized with the patient's heartbeat through electrodes, allowing for precise timing in the device's operation. During ventricular systole, the pump fills, which effectively reduces the workload of the left ventricle by decreasing afterload. Conversely, during ventricular diastole, the pump ejects, thereby enhancing cardiac output and improving blood flow to both the coronary and systemic circulations. The procedure begins with an incision made in the right chest along the infraclavicular line, where the pump is placed into a subcutaneous pocket above the pectoralis muscle. The pneumatic drive line is then tunneled through the skin to the right upper quadrant of the abdomen, where it connects to the console. An interposition vascular graft is anastomosed to the subclavian artery, and the main graft is linked to the pump. Following the connection, air is evacuated from the system, and the device is activated. Electrocardiogram electrodes are positioned on the chest wall and connected to the console, or alternatively, mechano-electrical skin interface electrodes may be placed on the wrist, finger, or ankle to capture the heartbeat for synchronization. The surgical site is checked for any bleeding, and hemostatic sealing agents may be applied as necessary before closing the incisions. In cases where replacement of the device is required, a similar incision is made to expose the pump and vascular graft, allowing for the clamping, excision, and replacement of the device as per the original insertion procedure. This comprehensive approach ensures that the aortic counterpulsation device functions effectively to support the patient's cardiac function.

1. Indications

The aortic counterpulsation ventricular assist system is indicated for patients experiencing severe cardiac conditions. The specific indications for this procedure include:

Acute Cardiogenic Shock - A critical condition where the heart suddenly cannot pump enough blood to meet the body's needs, often requiring immediate intervention.
End-Stage Chronic Heart Failure - A progressive condition where the heart's ability to pump blood is severely compromised, necessitating advanced therapeutic options to support cardiac function.

2. Procedure

The procedure for the insertion or replacement of the aortic counterpulsation ventricular assist system involves several detailed steps:

Step 1: Incision and Pocket Creation - An incision is made in the right chest along the infraclavicular line. This incision allows for the creation of a subcutaneous pocket above the pectoralis muscle, where the pneumatic pump will be placed.
Step 2: Tunneling the Drive Line - The pneumatic drive line is tunneled through the skin to the right upper quadrant of the abdomen. This step is crucial for connecting the pump to the console that drives its operation.
Step 3: Vascular Graft Anastomosis - An interposition vascular graft is anastomosed to the subclavian artery. This connection is essential for the proper functioning of the aortic counterpulsation device.
Step 4: Connecting the Pump - The main graft is then connected to the pump. This step ensures that the device can effectively assist in cardiac function.
Step 5: System Activation - Air is removed from the system, and the device is cycled on. This activation is critical for the device to begin its therapeutic function.
Step 6: Electrocardiogram Electrode Placement - Subcutaneous electrocardiogram electrodes are positioned in the chest wall and connected to the console. Alternatively, mechano-electrical skin interface electrodes may be placed over the wrist, finger, or ankle to capture the heartbeat and synchronize the pump's operation.
Step 7: Site Inspection and Sealing - The graft site is checked for any bleeding. If necessary, implantable hemostatic sealing agents may be placed to ensure hemostasis.
Step 8: Closure of Incisions - Finally, the incisions made during the procedure are closed, completing the insertion or replacement of the aortic counterpulsation device.

3. Post-Procedure

After the procedure, patients will require careful monitoring to assess the functionality of the aortic counterpulsation device and to ensure there are no complications. Expected recovery may involve observation for signs of bleeding at the graft site, as well as monitoring for any adverse reactions to the device. Patients may also need follow-up appointments to evaluate the device's performance and make any necessary adjustments to the therapeutic parameters. It is essential to provide appropriate post-operative care and education to the patient regarding the management of the device and recognition of potential complications.

Short Descr	INSJ/RPLCMT DEV VASC SEAL
Medium Descr	INSJ/RPLCMT IMPLTBL AORTIC VENTR VASC HEMO SEAL
Long Descr	Insertion or replacement of a permanently implantable aortic counterpulsation ventricular assist system, endovascular approach, and programming of sensing and therapeutic parameters; aortic counterpulsation device and vascular hemostatic seal
Status Code	Carriers Price the Code
Global Days	YYY - Carrier Determines Whether Global Concept Applies
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Inpatient Procedures, not paid under OPPS
Berenson-Eggers TOS (BETOS)	P5E - Ambulatory procedures - other
MUE	Not applicable/unspecified.