CPT® Code 33276

Insertion of phrenic nerve stimulator system (pulse generator and stimulating lead[s]), including vessel catheterization, all imaging guidance, and pulse generator initial analysis with diagnostic mode activation, when performed

The procedure described by CPT® Code 33276 involves the insertion of a phrenic nerve stimulator system, which is designed to assist patients suffering from moderate to severe central sleep apnea (CSA). CSA is a condition characterized by the temporary cessation of breathing due to the brain's failure to send signals to the muscles responsible for respiration. This can occur due to various factors, including cardiovascular disease, stroke, conditions affecting the neck or brainstem, morbid obesity, and the use of narcotics. The phrenic nerve stimulator system aims to restore normal breathing patterns by stimulating the diaphragm to contract, thereby maintaining rhythmic breathing during sleep.

The neurostimulator system consists of an implantable pulse generator (IPG) and stimulating leads. The IPG is typically implanted in a subcutaneous pocket located in the pectoral region, usually on the right side of the body. The stimulating lead is positioned in either the right brachiocephalic vein or the left pericardiophrenic vein (PPV), with the latter being the preferred site. In some cases, a pressure-sensing lead may also be placed in the azygos vein to monitor respiratory activity. The procedure is performed under conscious sedation, allowing the patient to communicate with the physician throughout the process. This careful approach ensures that the placement of the leads is accurate and minimizes the risk of complications.