CPT® Code 0458T

Deleted

The procedure described by CPT® Code 0458T involves the removal of a permanently implantable aortic counterpulsation ventricular assist system, specifically focusing on the subcutaneous electrode component. This system is utilized primarily in the management of acute cardiogenic shock or end-stage chronic heart failure. Its function is to alleviate the workload of the left ventricle while enhancing cardiac output and blood flow, which is critical in patients experiencing severe heart conditions. The aortic counterpulsation device comprises several key components, including a pneumatic pump, a console that operates the pump using pressurized air, and electrocardiogram electrodes that synchronize the device's operation 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 the main graft to connect to the pump. Additionally, subcutaneous electrocardiogram electrodes are strategically positioned on the chest wall and linked to the console, while mechano-electrical skin interface leads are placed over various arteries, such as the radial artery at the wrist, the digital artery at the finger, or the posterior tibial artery at the ankle, to effectively capture the heartbeat and ensure synchronization with the pump's operation. During the removal procedure, an incision is made to access the pump, vascular graft, pneumatic drive tubing, and any present subcutaneous electrodes. The device is clamped at the subclavian artery, the vascular graft is excised, and the artery is repaired. The pneumatic drive tubing and subcutaneous electrode are then disconnected from the console, allowing for the complete removal of the device. This procedure is critical for patients who no longer require the assistive device or who may be transitioning to other forms of treatment.