Basics of Pericardiocentesis CPT code 33016, 33017, 33018 & 33019

The physician drains excess fluid from around the heart. This is a life-saving procedure used to treat cardiac tamponade and for diagnosis and treatment of pericardial effusion. Pericardiocentesis may be performed as a “blind” subxiphoid procedure or with imaging guidance, such as CT, fluoroscopy, or echocardiography to visualize the heart and adjacent organs. Under local anesthesia, the patient is positioned supine or semirecumbent at a 30-60 degree angle to bring the heart closer to the anterior chest wall. A nasogastric tube may be placed to reduce the risk of gastric perforation.

A long needle is inserted below the sternum or the left sternocostal margin through the chest wall and into the pericardium, the protective tissue around the heart. When the needle is within the pericardial space, a small catheter and syringe are connected to the needle and excess fluid is aspirated or withdrawn. The needle is removed when no more fluid can be aspirated. In this post we will learn about Pericardiocentesis CPT code 33016, 33017, 33018 & 33019.

Pericardiocentesis is defined as ” the procedure to remove fluid that has built up in the sac around the heart (pericardium) also known as pericardial tap“.

From January 1, 2020, CPT codes 33010, 33011 and 33015 have been deleted. CPT code 76930 is also deleted. In the Cardiovascular subsection four new codes (33016-33019) along with new guidelines have been added to describe pericardiocentesis and pericardial drainage with insertion of indwelling catheter.

Read also: Coding guide for Thoracentesis CPT codes

Description of CPT code 33016, 33017, 33018 & 33019

For coding CPT code 33016, the physician should drain fluid from the pericardial space. The physician may perform this procedure using anatomic landmarks or under fluoroscopic or echocardiographic (ultrasound) guidance, which is not separately reportable. The physician places a long needle below the sternum and directs it into the pericardial space. When pericardial fluid is aspirated, the physician may advance a guidewire through the needle into the pericardial space and exchange the needle over the guidewire for a drainage catheter. The physician removes as much pericardial fluid as is required, removes the needle or catheter, and dresses the wound.

33016 Pericardiocentesis, including imaging guidance, when performed

Do not report 33016 in conjunction with 76942, 77002, 77012, 77021

For coding CPT code 33017, the physician drain fluid from the pericardial space.  The physician places a long needle percutaneously below the sternum and directs it into the pericardial space. When pericardial fluid flows back through the needle, the physician passes a guidewire through the needle into the pericardial space. The physician exchanges the needle over the wire for an indwelling drainage catheter. The physician attaches the catheter to a drainage bag, sutures the indwelling catheter into place on the chest wall, and dresses the wound.

CPT code 33017 is reported, when the procedure is performed on ages 6 years and older without a congenital cardiac anomaly.

CPT code 33018  is reported, when the procedure is performed on newborns to 5 years of age with a congenital cardiac anomaly, such as dextrocardia, heterotaxy, mesocardia, or a single ventricle anomaly, or for any age within the first 90-day postop period following surgical repair of a congenital cardiac anomaly

33017 Pericardial drainage with insertion of indwelling catheter, percutaneous, including fluoroscopy and/or ultrasound guidance, when performed; 6 years and older without congenital cardiac anomaly

33018 birth through 5 years of age or any age with congenital cardiac anomaly

Do not report 33017, 33018 in conjunction with 75989, 76942, 77002, 77012, 77021

In this procedure code 33019, the physician performs this procedure under CT guidance, which is included in this code and not reported separately.  The physician exchanges the needle over the wire for an indwelling drainage catheter. The physician attaches the catheter to a drainage bag, sutures the indwelling catheter into place on the chest wall, and dresses the wound.

33019 Pericardial drainage with insertion of indwelling catheter, percutaneous, including CT guidance

Do not report 33019 in conjunction with 75989, 76942, 77002, 77012, 77021

In order to report the pericardial drainage with insertion of indwelling catheter (CPT code 33017, 33018, 33019) the catheter needs to remain in place when the procedure is completed. CPT codes 33017, 33018, 33019 should not be reported when a catheter is placed to aspirate fluid and then removed at the conclusion of the procedure.

Deleted CPT codes for Pericardiocentesis

33010 Pericardiocentesis; initial

33011 Pericardiocentesis; subsequent

33015 Tube pericardiostomy

Read also : Coding guide for Paracentesis CPT codes

Read also: Coding guide for Fistulogram CPT code 36901

ICD-10 CM supporting CPT code 33016, 33017, 33018 & 33019