Summary & Overview
CPT 0682T: Removal of Pulse Generator for Diaphragmatic Stimulation System
CPT code 0682T denotes surgical removal of the pulse generator from a synchronized diaphragmatic stimulation system used to support cardiac function in patients with heart failure. The code captures a device explant procedure focused on opening a subcutaneous pocket and extracting the implantable pulse generator. Nationally, this code matters as adoption of implantable cardiac and diaphragmatic assist devices grows and payers refine coverage and payment policies for device management, revisions, and removals.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The overview addresses typical sites of service, clinical context for device explantation, and payer considerations that influence billing and coverage decisions. Readers will learn the clinical scope of the procedure, typical service settings, and which major payers are relevant for coverage discussions. The summary also indicates where input data is not available, such as associated taxonomies, ICD-10 diagnosis lists, and related procedural codes.
This publication is intended to provide a concise, national-level briefing on CPT code 0682T to support revenue cycle teams, clinicians, and policy analysts in understanding the code’s clinical purpose and payer context.
Billing Code Overview
CPT code 0682T describes the procedure to open a subcutaneous pocket and remove the pulse generator from a synchronized diaphragmatic stimulation system. The system is intended to support cardiac function in patients with heart failure by delivering synchronized diaphragmatic pacing to augment cardiac performance.
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Service type: Device removal (pulse generator explant) for a synchronized diaphragmatic stimulation system
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Typical site of service: Ambulatory surgical center or hospital outpatient setting; may also occur in an inpatient surgical environment depending on clinical status and facility capabilities
Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with chronic heart failure with reduced ejection fraction who has an implanted synchronized diaphragmatic stimulation (SDS) system presents for removal of the pulse generator due to device malfunction and recurrent pocket infection. The patient is evaluated preoperatively in the cardiac electrophysiology clinic with review of device interrogation, anticoagulation management, and imaging to assess the subcutaneous pocket. On the day of service, the patient arrives to an ambulatory surgery center or hospital outpatient surgical unit; local anesthesia with monitored anesthesia care or general anesthesia is selected based on comorbidities and procedural complexity. The provider makes an incision over the existing subcutaneous generator pocket, dissects to the device, disconnects and removes the pulse generator, inspects leads for integrity, cultures the pocket if infection is suspected, and irrigates and closes the pocket. Postoperative workflow includes device interrogation (if leads retained), wound care instructions, pain management, and disposition to home with outpatient follow-up for device replacement planning or continued infection management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when additional work or time beyond typical is documented (e.g., extensive scar tissue, complex removal). |
51 | Multiple procedures | Use when this service is billed the same day as other distinct procedures where multiple-procedure billing rules apply. |
52 | Reduced services | Use when the procedure was partially reduced or not completed as documented. |
53 | Discontinued procedure | Use when the procedure was started but terminated due to extenuating circumstances. |
62 | Co-surgeon | Use when two surgeons share responsibility for the procedure and both are qualified. |
66 | Surgical team | Use when a surgical team provides the procedure as defined by payer policy. |
78 | Unplanned return to OR by same physician following initial procedure | Use when the patient requires an immediate return to the operating room for a related complication. |
80 | Assistant surgeon | Use when an assistant surgeon actively assists during the procedure. |
81 | Minimum assistant surgeon | Use when minimal assistance is documented and payer allows this modifier. |
82 | Assistant surgeon when qualified resident unavailable | Use when an assistant is required because a qualified resident is not available. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist service as primary surgeon | Use when an eligible non-physician practitioner performs the procedure per payer policy. |
QK | Medical direction of two, three, or four qualified individuals | Use for anesthesia services when the physician medically directs multiple qualified individuals. |
QX | CRNA service with medical direction by a physician | Use when a CRNA performs anesthesia under physician direction. |
QY | Medical direction of one CRNA by an anesthesiologist | Use when a physician medically directs one CRNA. |
TG | Via telemedicine, for professional component or other applicable services | Use when portions of perioperative evaluation or follow-up are completed via telemedicine per payer rules. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RP0000X | Cardiovascular Disease (Cardiology) | Electrophysiology and heart failure specialists who manage device therapy. |
| 2084P0800X | Electrophysiology | Physicians specializing in device implantation and explantation. |
| 208D00000X | General Surgery | Surgeons who may be involved in complex pocket revisions or infected device removal. |
| 363L00000X | Nurse Practitioner | Advanced practice providers who participate in perioperative and follow-up care. |
| 364S00000X | Physician Assistant | Midlevel providers assisting in procedure workflow and postoperative care. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I50.22 | Chronic systolic (congestive) heart failure | Primary heart failure diagnosis in patients receiving synchronized diaphragmatic stimulation therapy. |
I50.23 | Acute on chronic systolic (congestive) heart failure | Worsening heart failure that may prompt device evaluation and possible generator management. |
T85.711A | Breakdown (mechanical) of pacemaker and leads, initial encounter | Used for device malfunction or mechanical failure of an implanted device requiring generator removal. |
T86.798A | Other complication of transplanted heart and/or heart-assist device, initial encounter | Used when complications related to cardiac assist devices overlap with device therapy management. |
T81.4XXA | Infection following a procedure, initial encounter | Applies when pocket infection is the indication for generator explantation. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
33207 | Removal of permanent pacemaker pulse generator only | Similar procedural step when removing a cardiac device generator; used when pacemaker generator rather than SDS generator is explanted. |
33233 | Removal of implantable cardioverter-defibrillator, pulse generator only | Analogous removal CPT for ICD generators; relevant when workflow and coding principles apply to generator explant. |
33234 | Removal with replacement of implantable cardioverter-defibrillator pulse generator | Relevant when removal is followed immediately by replacement in the same encounter. |
33244 | Revision, repair, or relocation of pacemaker lead, open procedure | Performed when leads require open revision during pocket surgery. |
10060 | Incision and drainage of abscess; simple or single | May be performed if pocket infection requires drainage in conjunction with generator removal. |