CPT® Code 0461T

Official Description

Repositioning of previously implanted aortic counterpulsation ventricular assist device; aortic counterpulsation device

Common Language Description

The procedure described by CPT® Code 0461T involves the repositioning of a previously implanted aortic counterpulsation ventricular assist device. This device is utilized primarily in the management of acute cardiogenic shock or end-stage chronic heart failure. The aortic counterpulsation device is a sophisticated system that includes 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 in a subcutaneous pocket located above the pectoralis muscle, allowing for a minimally invasive approach. The pneumatic drive line exits through the skin in the right upper abdomen, connecting to the console that controls the device's operation. To facilitate the device's function, an interposition vascular graft is surgically anastomosed to the subclavian artery, ensuring proper blood flow to the pump. Additionally, subcutaneous electrocardiogram electrodes are positioned on the chest wall and linked to the console, while mechano-electrical skin interface electrocardiogram leads are placed over the wrist, finger, or ankle to effectively capture the heartbeat. This synchronization is crucial as the pump fills during ventricular systole, which reduces the workload on the left ventricle by decreasing afterload, and ejects during ventricular diastole, thereby enhancing cardiac output and improving both coronary and systemic blood flow. When the need arises to reposition the device, a surgical incision is made to expose the pump, subclavian artery, and vascular graft. The device is then carefully repositioned within the existing subcutaneous pocket, and the vascular graft is inspected for any signs of bleeding, while the pneumatic drive tubing is checked for kinking. The subcutaneous electrodes are also repositioned and tested to ensure they adequately capture the heartbeat. Finally, the incisions are closed with sutures, completing the procedure. It is important to note that CPT® Code 0460T is used to report the repositioning of the subcutaneous electrode, while CPT® Code 0461T specifically pertains to the repositioning of the aortic counterpulsation device itself.

1. Indications

The procedure represented by CPT® Code 0461T is indicated for patients experiencing acute cardiogenic shock or end-stage chronic heart failure. These conditions necessitate the use of an aortic counterpulsation ventricular assist device to support cardiac function and improve hemodynamic stability.

Acute Cardiogenic Shock A critical condition characterized by the heart's inability to pump sufficient 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 is unable to maintain adequate circulation, leading to significant morbidity and mortality.

2. Procedure

The procedure for repositioning the aortic counterpulsation ventricular assist device involves several critical steps to ensure the device functions optimally after relocation.

Step 1: Incision An incision is made in the skin to access the previously implanted aortic counterpulsation device. This incision is carefully carried down to expose the pump, subclavian artery, and vascular graft, allowing the surgeon to work effectively on the device.
Step 2: Device Repositioning The aortic counterpulsation device is then repositioned within the existing subcutaneous pocket. This step is crucial to ensure that the device remains properly situated for optimal performance.
Step 3: Vascular Graft Inspection After repositioning the device, the vascular graft is thoroughly checked for any signs of bleeding. This inspection is vital to prevent complications that could arise from inadequate hemostasis.
Step 4: Pneumatic Drive Tubing Check The pneumatic drive tubing is examined for kinking, which could impede the function of the device. Ensuring that the tubing is free from obstructions is essential for the device's operation.
Step 5: Electrodes Repositioning The subcutaneous electrocardiogram electrodes are repositioned to ensure they are correctly placed for optimal capture of the heartbeat. This step is critical for the synchronization of the device with the patient's cardiac rhythm.
Step 6: Testing The repositioned electrodes are tested to confirm adequate capture of the heartbeat, ensuring that the device will function correctly in its new position.
Step 7: Closure Finally, the incisions made during the procedure are closed with sutures, completing the surgical intervention.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications related to the repositioning of the aortic counterpulsation device. This includes observing for signs of bleeding at the incision site, ensuring the device is functioning properly, and confirming that the electrocardiogram electrodes are effectively capturing the heartbeat. Patients may require follow-up imaging or assessments to evaluate the device's position and performance. Additionally, healthcare providers will provide instructions for wound care and any necessary activity restrictions to promote healing and prevent complications.

Short Descr	REPOS AORTIC CONTRPULSJ DEV
Medium Descr	REPOS AORTIC VENTR DEV SUBQ ELECT CONTRPULSJ DEV
Long Descr	Repositioning of previously implanted aortic counterpulsation ventricular assist device; aortic counterpulsation device
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.