CPT® Code 33237

The procedure described by CPT® Code 33237 involves the removal of a permanent epicardial pacemaker and its associated electrodes through a surgical approach known as thoracotomy. This specific code is utilized when a dual lead system is being removed, which means that the pacemaker has two electrodes, one typically placed in the atrium and the other in the ventricle of the heart. The process begins with the opening of the pacemaker pocket, where the epicardial electrode, which is the lead or wire connected to the pacemaker generator, is disconnected. Following this, the generator itself is removed, and the pocket is subsequently closed. The surgical approach to access the heart can vary, including median sternotomy, subxiphoid, or subcostal techniques, all of which involve opening the chest to expose the heart. Once the heart is accessible, the epicardial pacemaker electrode is carefully dissected from any surrounding tissue that may have adhered to it along its path through the thorax and at its point of attachment to the pericardium. After the electrode is successfully removed, chest tubes may be placed as necessary to facilitate drainage, and the chest is then closed. This procedure is critical for patients who require the removal of a dual lead epicardial pacemaker due to various clinical reasons, such as device malfunction or the need for replacement.