Summary & Overview
CPT 33236: Pacemaker System Removal via Thoracotomy
CPT code 33236 represents the open surgical removal of an implanted pacemaker system via thoracotomy, including explantation of atrial or ventricular leads and subcutaneous removal of the pulse generator. This procedure is a high-acuity cardiac surgical service with implications for inpatient surgical capacity, perioperative cardiothoracic expertise, and device management protocols. Nationally, the code is relevant for hospitals, cardiothoracic surgery programs, and payers managing high-cost device procedures and potential complications.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on clinical context, typical site of service, and the types of benchmarks and policy content commonly associated with this service line. The publication summarizes reimbursement and utilization benchmarks where available, highlights relevant billing and coding considerations, and outlines clinical context such as indications for explantation and care setting requirements. Data not available in the input is noted where applicable. The goal is to provide administrators, coders, and policy stakeholders a focused, national-level overview to inform coding accuracy, billing workflows, and payer discussions related to CPT code 33236.
Billing Code Overview
CPT code 33236 describes a surgical procedure to remove an implanted pacemaker system through a thoracotomy and subcutaneous removal of the pacemaker generator. The procedure involves a thoracotomy to access and extract the atrial or ventricular lead from the heart surface and removal of the subcutaneous pacemaker generator from the chest wall.
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Service type: Open surgical removal of pacemaker system (thoracotomy with lead and generator explantation)
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Typical site of service: Inpatient hospital operating room or thoracic surgery suite for open chest surgery
Clinical & Coding Specifications
Clinical Context
A 72-year-old male with a dual-lead transvenous pacemaker presents with device malfunction and recurrent pocket infection with surrounding erythema and purulent drainage. After evaluation by cardiology and cardiothoracic surgery, the decision is made to remove the entire pacemaker system, including the subcutaneous generator and atrial and ventricular leads. The patient is brought to the operating room, placed under general anesthesia, and prepped for a thoracotomy approach due to chronic lead adhesions and need for direct visualization. The surgeon performs a thoracotomy to access the chest cavity, dissects adherent leads from the epicardial or endocardial surfaces as indicated, and removes the atrial and ventricular leads. The subcutaneous generator is explanted from the chest wall pocket. Hemostasis is secured, the thoracotomy is closed, and the patient is transferred to recovery with appropriate post‑operative monitoring and antibiotic therapy.
This procedure is typically performed in an inpatient operating room or cardiothoracic surgical suite, often by a cardiothoracic surgeon with electrophysiology and anesthesia support. The clinical workflow includes preoperative imaging and device interrogation, informed consent, perioperative antibiotics, lead and generator explantation, and post‑operative wound and device site care. Indications include device infection, lead malfunction, lead endocarditis, or need for system removal prior to device replacement or upgrade.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
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