CPT® Code 0455T

Official Description

Removal of permanently implantable aortic counterpulsation ventricular assist system; complete system (aortic counterpulsation device, vascular hemostatic seal, mechano-electrical skin interface and electrodes)

Common Language Description

The procedure described by CPT® Code 0455T involves the removal of a permanently implantable aortic counterpulsation ventricular assist system. This system is utilized primarily in the management of acute cardiogenic shock or end-stage chronic heart failure. The primary function of the device is to reduce the workload of the left ventricle while simultaneously enhancing cardiac output and blood flow. The aortic counterpulsation device comprises several components, including a pneumatic pump, a console that operates the pump using pressurized air, and electrocardiogram electrodes that facilitate synchronization with the patient's heartbeat. The pump is surgically placed in a subcutaneous pocket located above the pectoralis muscle, with a pneumatic drive line exiting through the skin in the right upper abdomen to connect to the console. An interposition vascular graft is surgically anastomosed to the subclavian artery, allowing for effective blood flow management, while the main graft connects to the pump. Additionally, subcutaneous electrocardiogram electrodes are strategically positioned on the chest wall and linked to the console, with mechano-electrical skin interface leads placed over the wrist, finger, or ankle to capture the heartbeat and ensure proper synchronization of the pump. The removal procedure entails making an incision to access the pump, vascular graft, pneumatic drive tubing, and any subcutaneous electrodes. The device is clamped at the subclavian artery, the vascular graft is excised, and the subclavian artery is repaired. The pneumatic drive tubing and electrodes are disconnected, allowing for the complete removal of the device. Code 0455T specifically reports the removal of the entire system, which includes the aortic counterpulsation device, vascular hemostatic seal, mechano-electrical skin interface, and electrodes.

1. Indications

The procedure associated with CPT® Code 0455T is indicated for patients experiencing acute cardiogenic shock or end-stage chronic heart failure. These conditions necessitate the use of aortic counterpulsation devices to alleviate the strain on the left ventricle and improve overall cardiac output and blood flow.

Acute Cardiogenic Shock A critical condition where the heart suddenly cannot pump enough blood to meet the body's needs, often requiring mechanical support.
End-Stage Chronic Heart Failure A severe form of heart failure where the heart's ability to function is significantly compromised, necessitating advanced therapeutic interventions.

2. Procedure

The removal of the aortic counterpulsation ventricular assist system involves several detailed steps to ensure complete extraction of the device while minimizing complications.

Step 1: Incision An incision is made in the skin to access the implanted device. This incision is carefully placed to allow for optimal exposure of the pump and associated components.
Step 2: Exposure The incision is extended to expose the pump, the subclavian artery, the vascular graft, the pneumatic drive tubing, and any subcutaneous electrodes that may be present. This step is crucial for ensuring that all components of the device are accessible for removal.
Step 3: Clamping The device is clamped at the subclavian artery to prevent any blood loss during the removal process. This step is essential for maintaining hemostasis while the device is being excised.
Step 4: Vascular Graft Excision The vascular graft is carefully excised from the subclavian artery. This requires precision to avoid damaging surrounding tissues and to ensure a clean removal.
Step 5: Repair of Subclavian Artery After the vascular graft is removed, the subclavian artery is repaired using clips or sutures to restore normal blood flow and integrity of the vessel.
Step 6: Disconnection of Pneumatic Drive Tubing The pneumatic drive tubing is disconnected from the console, which is a critical step in the removal process to ensure that the device is completely detached from its power source.
Step 7: Removal of Subcutaneous Electrodes Any subcutaneous electrodes that were used to synchronize the device with the heartbeat are also disconnected and removed, completing the extraction of the entire system.
Step 8: Complete Device Removal Finally, the entire unit, including the aortic counterpulsation device, vascular hemostatic seal, mechano-electrical skin interface, and electrodes, is removed from the patient's body.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any signs of complications, such as bleeding or infection at the incision site. Patients may require supportive care to manage their heart failure symptoms following the removal of the device. Recovery time can vary based on the patient's overall health and the complexity of the procedure, and follow-up appointments are essential to assess the patient's cardiac function and recovery progress.

Short Descr	REMVL AORTIC VENTR CMPL SYS
Medium Descr	REMVL PERM IMPLT AORTIC VENTR COMPLETE SYSTEM
Long Descr	Removal of permanently implantable aortic counterpulsation ventricular assist system; complete system (aortic counterpulsation device, vascular hemostatic seal, mechano-electrical skin interface and electrodes)
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.