Clinical Context
A typical patient is an adult with an implanted baroreflex activation therapy (BAT) system who presents for targeted removal of the BAT lead due to lead malfunction, lead infection limited to the lead, lead displacement, or pain at the lead site. The patient has a history of resistant hypertension or heart failure for which BAT was previously implanted. Pre-procedure workflow includes clinical evaluation, review of device interrogation reports, imaging if lead position or integrity is in question, medication reconciliation, and informed consent focused on lead removal risks and possible need for full system explantation. On the day of service, the patient undergoes local or general anesthesia based on provider assessment, sterile exposure of the generator pocket and lead tract, isolation and extraction of the lead only while leaving any generator or additional leads intact. Intraoperative monitoring includes hemodynamic surveillance and device interrogation. Post-procedure workflow includes wound care, post-extraction device check if generator remains, observation for bleeding or infection, documentation of procedure details including reason for lead removal and whether complete or partial removal was achieved, and planning for re-implantation or alternative therapy if indicated. Typical sites of service are the hospital operating room, ambulatory surgery center, or interventional suite depending on patient comorbidity and institutional practice.
Coding Specifications
| Modifier | Description | When to Use |
|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for the procedure. |
52 | Reduced services | Use when a service is partially reduced or not completed as described by the code.
53 | Discontinued procedure | Use when the procedure is started but discontinued due to extenuating circumstances.
59 | Distinct procedural service | Use to indicate a separate, distinct procedure not normally reported together.
76 | Repeat procedure by same physician | Use when the same physician repeats the procedure later the same day.
77 | Repeat procedure by another physician | Use when a different physician repeats the procedure later the same day.
78 | Return to operating room for related procedure during postoperative period | Use when the patient returns to the OR for a related procedure during the global period.
79 | Unrelated procedure or service during the postoperative period | Use when an unrelated procedure is performed during the global period.
RT | Right side | Use when laterality is reportable and the procedure is performed on the right side.
LT | Left side | Use when laterality is reportable and the procedure is performed on the left side.
| Taxonomy Code | Specialty | Notes |
|---|
207RH0000X | Cardiovascular Surgeon | Surgeons who may remove BAT leads in OR settings. |
2084P0800X | Cardiac Electrophysiologist | Specialists who manage device systems and perform lead extractions.
208D00000X | General Surgery | Surgeons in centers that manage device explant procedures.
207K00000X | Thoracic Surgery | Thoracic surgeons involved when lead location requires chest access.
2086S0102X | Interventional Cardiology | Interventionalists performing device lead procedures in cath or hybrid suites.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
I10 | Essential (primary) hypertension | Common indication for initial BAT implantation; lead removal may occur for lead complications. |
I50.22 | Chronic systolic (congestive) heart failure | Heart failure is an indication for BAT in some patients; device lead issues may prompt removal.
T86.89 | Other complications of transplanted organ and tissue, not elsewhere classified | Used when describing device-related complications or local device-related tissue reaction when no specific code fits.
T82.7XXA | Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter | Applicable when lead infection is the reason for removal.
T82.92XA | Other mechanical complication of other cardiac and vascular devices, implants and grafts, initial encounter | Used when lead malfunction or mechanical failure prompts extraction.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
64658 | Removal of lead(s) of baroreflex activation therapy (BAT) system; lead only | Primary code for isolated removal of BAT lead without generator explantation. |
33233 | Removal of pacemaker lead(s), transvenous, with or without subcutaneous tunneling; lead(s) only | Similar extraction technique codes when transvenous lead removal is performed; used when pacemaker leads are involved.
33235 | Removal of pacemaker pulse generator with explantation of existing leads, single lead | Used when pulse generator removal and lead explantation are performed together; relates when full system explantation is required.
64568 | Removal of neurostimulator lead, each lead, percutaneous or open (e.g., spinal cord stimulator) | Related extraction code for other neuromodulation systems; technique and documentation considerations are similar.
33234 | Removal of pacemaker lead(s) requiring extractions and/or specialized tools (open or transvenous) | Used when complex extraction requiring specialized tools or techniques is necessary; clinically relevant if BAT lead requires advanced extraction.