CPT® Code 0459T

Deleted

Relocation of skin pocket with replacement of implanted aortic counterpulsation ventricular assist device, mechano-electrical skin interface and electrodes

The procedure described by CPT® Code 0459T involves the relocation of a skin pocket associated with an implanted aortic counterpulsation ventricular assist device. This device is a sophisticated medical apparatus designed to support patients with severe heart conditions, such as acute cardiogenic shock or end-stage chronic heart failure. The aortic counterpulsation system 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 function with the patient's heartbeat. The pump is strategically placed within a subcutaneous pocket located above the pectoralis muscle, allowing for optimal positioning and function. The pneumatic drive line, which is essential for the operation of the pump, exits through the skin in the right upper abdomen and connects to the console, facilitating the necessary communication and power supply. An interposition vascular graft is surgically anastomosed to the subclavian artery, ensuring that the pump receives adequate blood flow. Additionally, subcutaneous electrocardiogram electrodes are 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. These leads are crucial for capturing the heartbeat and ensuring the pump operates in sync with the cardiac cycle. During the procedure, the pump fills with blood during ventricular systole, which reduces the workload of the left ventricle by decreasing afterload. Conversely, during ventricular diastole, the pump ejects blood, thereby enhancing cardiac output and improving both coronary and systemic blood flow. The relocation of the device involves making an incision to access the pump, subclavian artery, and vascular graft, followed by the creation of a new pocket in the subcutaneous tissue for the device. The surgical team meticulously checks the vascular graft for any signs of bleeding and ensures that the pneumatic drive tubing is free from kinks. Finally, the positioning of the mechano-electrical skin interface and subcutaneous electrodes is verified to ensure they adequately capture the heartbeat before the incisions are closed with sutures.