CPT® Code 33287

1. Indications

The removal and replacement of a phrenic nerve stimulator, as described by CPT® Code 33287, is indicated for patients who have a previously implanted phrenic nerve stimulator system that is no longer functioning effectively or has reached the end of its operational life. This procedure is specifically performed for individuals diagnosed with moderate to severe central sleep apnea (CSA), where the device is essential for maintaining adequate respiratory function during sleep.

• Moderate to Severe Central Sleep Apnea (CSA) The procedure is indicated for patients experiencing significant breathing interruptions during sleep due to CSA, necessitating the use of a phrenic nerve stimulator to assist in diaphragm contraction and improve breathing patterns.

2. Procedure

The procedure for the removal and replacement of a phrenic nerve stimulator involves several critical steps to ensure the safe and effective transition to a new device.

• Step 1: Incision and Exposure An incision is made over the existing device located in its subcutaneous pocket. This initial step is crucial as it allows the surgeon to access the implanted phrenic nerve stimulator and its associated lead(s). Care is taken to minimize tissue damage during this process.
• Step 2: Disconnection and Removal Once the device is exposed, the surgeon carefully frees the device and lead(s) from the surrounding tissue. The lead(s) are then disconnected from the existing pulse generator, which is subsequently removed from the pocket. This step may involve assessing the condition of the pocket to determine if any revisions are necessary before placing a new generator.
• Step 3: Placement of New Generator After the existing generator is removed, a new pulse generator is placed in the pocket. The surgeon ensures that the pocket is adequately prepared for the new device, which may include making any necessary adjustments to accommodate the new generator.
• Step 4: Reconnection of Lead(s) The existing lead(s) are reconnected to the new pulse generator. This step is critical as it ensures that the stimulation system is fully operational and ready to assist the patient in maintaining proper respiratory function.
• Step 5: Closure Finally, the incision site is closed, completing the procedure. The surgeon ensures that the area is properly sutured to promote healing and minimize the risk of infection.

3. Post-Procedure

After the removal and replacement of the phrenic nerve stimulator, patients are typically monitored for any immediate complications related to the surgery. Post-procedure care may include pain management, wound care instructions, and follow-up appointments to assess the functionality of the new device. Patients may also undergo programming and interrogation of the new pulse generator to ensure it is functioning correctly and providing the necessary stimulation for effective breathing. It is essential for patients to report any unusual symptoms or discomfort during their recovery period to their healthcare provider.