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Coding Tip of the Month – December 2019

Subcutaneous Implantable Cardioverter Defibrillator

The PCS updates for October 1st, 2019 included a new device character “F Subcutaneous Defibrillator Lead” in several tables in the Subcutaneous Tissue and Fascia body system.

The use of implantable cardioverter defibrillators (ICDs) is an established therapy for the prevention of death from ventricular arrhythmia. Existing conventional ICDs rely on transvenous leads for cardiac sensing and defibrillation. Complications of defibrillator implantation have been associated mainly with transvenous lead insertion and have included pneumothorax, hemothorax and cardiac tamponade. Difficulties in achieving venous access can prolong the procedure and occasionally result in failed ICD implantation. Lead failure either generates inappropriate shocks or impedes appropriate therapy. Moreover, failed leads often require removal, a procedure that is associated with substantial morbidity and mortality.

Subcutaneous defibrillators provide a safer therapy for ventricular tachyarrythmias in cases where cardiac pacing is not necessary. In this procedure the subcutaneous electrode is positioned parallel to and 1 to 2 cm to the left of the sterna midline. The electric pulse generator is implanted just below the axilla. The tables affected are:

0JH Subcutaneous Tissue and Fascia, Insertion:

Body Part Approach Approach Device Qualifier
6 Subcutaneous Tissue and Fascia, Chest   0 Open 3 Percutaneous F Subcutaneous Defibrillator Lead   Z No Qualifier  

0JP Subcutaneous Tissue and Fascia, Removal

0JW Subcutaneous Tissue and Fascia, Revision

Body Part Approach Approach Device Qualifier
T Subcutaneous Tissue and Fascia, Trunk 0 Open 3 Percutaneous F Subcutaneous Defibrillator Lead   Z No Qualifier  

Prior to the update procedures involving the insertion, removal, or revision of a subcutaneous implantable cardioverter defibrillator lead were captured using the device value “P Cardiac Rhythm Related Device”  with the appropriate subcutaneous tissue and fascia body part value and the applicable approach value in tables 0JH, 0JP and 0JW, root operations Insertion, Removal, and Revision respectively.