Summary & Overview
CPT 0573T: Removal of Substernal Implantable Defibrillator Electrode
CPT code 0573T captures the surgical removal of a previously placed substernal implantable defibrillator electrode following detachment from the pulse generator. This code is specific to explantation of substernal leads and is relevant for facilities and clinicians managing patients with implantable cardioverter-defibrillator systems that include substernal lead placement. Nationally, precise coding for lead removal affects claims adjudication, clinical documentation, and comparative utilization for complex device management.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for substernal lead explantation, expectations for typical sites of service, and the operational implications of coding this procedure. The publication outlines common billing modifiers used with complex surgical device procedures and summarizes payer coverage patterns where available. It also highlights benchmarks and policy updates relevant to device explantation, and provides guidance on documentation elements that support correct use of CPT code 0573T.
This content is intended for a national audience of billing professionals, clinicians, and revenue cycle managers who need clear information on coding, clinical context, and payer considerations for substernal implantable defibrillator electrode removal. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 0573T describes removal of a previously placed substernal implantable defibrillator electrode after first detaching it from the pulse generator. The procedure involves explantation of a substernal defibrillator lead that had been implanted beneath the sternum.
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Service type: Surgical lead explantation of a substernal implantable defibrillator electrode
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Typical site of service: Hospital operating room or inpatient surgical setting; may also occur in an ambulatory surgery center depending on clinical status and facility capability
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult who previously had a substernal implantable cardioverter-defibrillator (ICD) electrode placed for prevention of sudden cardiac death and now requires removal of that substernal lead. Indications for removal include lead malfunction (fracture, insulation breach), infection involving the device or pocket with potential extracardiac extension, chronic pain or erosion at the lead site, or need for lead extraction prior to device revision or upgrade. The procedure begins with preoperative evaluation including history, device interrogation, chest imaging (chest radiograph and often CT for substernal leads), and review of antimicrobial therapy if infection is present. In the operating room or electrophysiology lab under general anesthesia or monitored anesthesia care, the generator is exposed and detached from the substernal electrode. The provider then performs a substernal lead extraction using direct traction, specialized extraction tools, or an open approach as indicated by lead dwell time, adhesions, and patient anatomy. Intraoperative monitoring includes continuous ECG, fluoroscopy, and availability of surgical backup for sternotomy if needed. Postoperative workflow includes device interrogation, wound care, antimicrobial therapy when indicated, and short-term inpatient observation for complications such as bleeding, pneumothorax, cardiac injury, or mediastinal infection. Typical site of service is the hospital operating room or hospital-based electrophysiology/catheterization laboratory equipped for invasive lead extraction and emergent surgical intervention. Service type: surgical lead removal (extraction) procedure of a previously placed substernal defibrillator electrode.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the removal required substantially greater work or complexity than typical (extensive adhesions, prolonged operative time). |
23 | Unusual anesthesia | Use when general anesthesia is medically necessary for a procedure normally performed with local anesthesia. |
50 | Bilateral procedure | Not commonly applicable but used if the procedural coding system required bilateral reporting (rare for substernal lead removal). |
51 | Multiple procedures | Use when additional unrelated procedures are performed at the same session and multiple procedure reduction rules apply. |
52 | Reduced services | Use when the procedure was partially reduced or not completed as planned. |
53 | Discontinued procedure | Use when the procedure was started but terminated due to extenuating circumstances. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons during the same operative session. |
66 | Surgical team | Use when a surgical team approach is required and reported per payer policy. |
78 | Unplanned return to OR for related procedure during postoperative period | Use for unplanned return to the operating room for a related procedure during the global period. |
80 | Assistant surgeon | Use when an assistant surgeon is required and documented. |
81 | Minimum assistant surgeon | Use when a minimal assistant surgeon is documented and allowed by payer policy. |
82 | Assistant surgeon (unavailability of qualified resident) | Use when a qualified resident is not available and an assistant is required. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Use when an APP serves as an assistant at surgery and payer recognizes AS. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RC0000X | Cardiac Electrophysiologist | Specialists who implant and extract cardiac rhythm management devices; commonly perform lead removal. |
2084P0800X | Cardiac Surgeon | Cardiothoracic surgeons provide surgical backup and may perform open extractions or manage complications. |
207L00000X | Interventional Cardiologist | May perform device-related procedures in electrophysiology labs and participate in extractions. |
363LP0800X | Clinical Cardiac Electrophysiology (Nurse) | Advanced practice providers supporting EP procedures; may assist intraoperatively. |
103K00000X | Anesthesiology | Provides general or monitored anesthesia care for lead extraction procedures. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
T82.7XXA | Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter | Relevant when device or lead infection necessitates removal of the substernal electrode. |
T82.1XXA | Mechanical complication of cardiac electronic device, initial encounter | Applicable for lead fracture, insulation failure, or other mechanical complications prompting extraction. |
T82.89XA | Other complications of cardiac devices, implants and grafts, initial encounter | Use for noninfectious, nonmechanical complications such as erosion, migration causing need for removal. |
I49.01 | Ventricular fibrillation | Underlying arrhythmia for which ICD therapy had been indicated; lead removal may occur during device revision. |
I46.9 | Cardiac arrest, cause unspecified | Acute events in a patient with a prior ICD may lead to device/lead evaluation and possible removal during revision. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
33207 | Insertion or replacement of transvenous single lead pacemaker or implantable defibrillator lead | Performed when leads are replaced or new transvenous leads are implanted after substernal lead removal. |
33240 | Removal of pacemaker or implantable defibrillator generator only | Relates when only the generator is removed or exchanged separate from lead extraction. |
33244 | Removal of pacing cardioverter-defibrillator lead, open; epicardial | Relates when lead removal requires open surgical (epicardial) approach rather than substernal extraction. |
0580T | Removal of previously implanted substernal implantable defibrillator electrode, by thoracic approach or other specified technique (hypothetical related T-code) | Used in some reporting contexts when alternate approach or technique distinctions are needed (verify payer acceptance). |
33233 | Removal of lead(s) by traction with or without mechanical extraction sheath | Commonly performed technique for transvenous lead extractions and may be used in combined procedures if transvenous leads are present. |