CPT® Code 33238

The procedure described by CPT® Code 33238 involves the surgical removal of one or more permanent transvenous electrodes through a thoracotomy. Transvenous electrodes, also known as endocardial electrodes, are typically used in cardiac pacing and defibrillation. These electrodes may need to be extracted due to various reasons, including damage or malfunction of the lead(s), infection at the site of the generator or lead(s), or complications such as interference with blood flow caused by the lead(s). A thoracotomy is indicated when the electrodes cannot be safely removed using a transvenous approach, which may occur in cases where there is dense scar tissue and adhesions or when the electrodes are deeply embedded within the myocardium, the heart muscle itself. During the procedure, a surgical incision is made in the chest over the pacemaker generator, allowing access to disconnect the lead. The heart is then exposed through a median sternotomy, which involves opening the chest cavity to provide a clear view of the heart. In certain cases, if cardiopulmonary bypass is necessary, the aorta is cannulated, followed by the superior and inferior vena cava to facilitate the procedure. The removal of the electrodes may involve incising the right atrium to access an atrial electrode or making an incision in the right ventricle for a ventricular electrode. The surgeon carefully dissects the electrode free from any adhesive scar tissue before removal. After the electrodes are extracted, the heart wall incisions are closed, and chest tubes may be placed as needed to ensure proper drainage. Finally, the chest is closed to complete the procedure.