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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.
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The insertion of a phrenic nerve stimulator system is indicated for patients diagnosed with moderate to severe central sleep apnea (CSA). This condition is characterized by the brain's intermittent failure to signal the muscles that control breathing, leading to disrupted sleep and potential health complications. The following conditions may contribute to the development of CSA:
The procedure for inserting a phrenic nerve stimulator system involves several detailed steps to ensure proper placement and functionality of the device. The process begins with the patient receiving conscious sedation, allowing for communication with the physician during the procedure.
After the insertion of the phrenic nerve stimulator system, patients are typically monitored for any immediate complications related to the procedure. Post-procedure care may include instructions on activity restrictions, wound care, and follow-up appointments to assess the functionality of the device. Patients may also receive guidance on how to operate the stimulator and any necessary adjustments that may be required. The expected recovery period can vary, but patients are generally advised to avoid strenuous activities for a specified duration to allow for proper healing and integration of the device.
| Short Descr | INSJ PHRNC NRV STIM SYS | Medium Descr | INSERTION PHRENIC NERVE STIMULATOR SYSTEM | Long Descr | 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 | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Not Discounted when Multiple | ASC Payment Indicator | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
This is a primary code that can be used with these additional add-on codes.
| 33277 | Add On Code Resequenced Code MPFS Status: Active Code APC N ASC N1 Insertion of phrenic nerve stimulator transvenous sensing lead (List separately in addition to code for primary procedure) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | GC | This service has been performed in part by a resident under the direction of a teaching physician | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2024-01-01 | Added | Code Added. |
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