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The procedure described by CPT® Code 33018 involves the pericardial drainage with the insertion of an indwelling catheter using a percutaneous approach. The pericardial sac, which is a thin, two-layer membrane encasing the heart, contains a small volume of fluid that serves to minimize friction during heartbeats. However, various conditions such as infections, malignancies, inflammation, injuries, drug reactions, or metabolic disorders can lead to an accumulation of excess fluid, known as pericardial effusion. This condition can significantly impair cardiac function. To alleviate this issue, a pericardial drainage procedure is performed, which may utilize imaging guidance techniques such as fluoroscopy, ultrasound, or computed tomography (CT) to ensure accurate placement of the catheter. During the procedure, local anesthesia is administered, and a needle is inserted through the chest wall into the pericardial space. The needle is carefully advanced through the outer membrane of the pericardial sac into the fluid-filled cavity. A flexible catheter is then threaded through the needle into the pericardial sac, after which the needle is removed. The catheter is secured to the chest wall using sutures and/or tape to prevent dislodgment. Once secured, the catheter allows for the aspiration of fluid, which can be done initially with a syringe or by connecting the catheter to a drainage bag for continuous drainage. It is important to note that ultrasound guidance requires direct skin contact with a probe, which may not be feasible in patients who have undergone recent cardiothoracic surgery due to potential obstructions from incisions or dressings. Conversely, fluoroscopic guidance does not necessitate contact but may lack the comprehensive field of view or detailed spatial resolution required for certain cases. CT guidance offers superior visualization of thoracic and cardiac structures, which can be particularly beneficial for complex procedures involving the pericardial sac. This code specifically applies to patients from birth through 5 years of age or any age with a congenital cardiac anomaly, distinguishing it from other related codes that cater to different age groups or conditions.
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The procedure associated with CPT® Code 33018 is indicated for the management of pericardial effusion, which can occur due to various underlying conditions. The specific indications for performing this procedure include:
The procedure for pericardial drainage with the insertion of an indwelling catheter involves several critical steps, which are outlined as follows:
After the pericardial drainage procedure, the patient is monitored for any complications or adverse effects. Expected recovery includes observation for signs of infection, bleeding, or further fluid accumulation. The catheter may remain in place for a period to allow for ongoing drainage of fluid, and the healthcare team will provide instructions for care at the catheter site. Follow-up imaging may be necessary to assess the effectiveness of the drainage and to monitor the patient's condition. The healthcare provider will also evaluate the need for further interventions based on the underlying cause of the pericardial effusion.
| Short Descr | PRCRD DRG 0-5YR OR W/ANOMLY | Medium Descr | PERQ PRCRD DRG 0-5YR/ANY AGE W/CGEN CAR ANOMALY | Long Descr | Pericardial drainage with insertion of indwelling catheter, percutaneous, including fluoroscopy and/or ultrasound guidance, when performed; birth through 5 years of age or any age with congenital cardiac anomaly | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. |
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| 2020-01-01 | Added | Code added. |
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