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The procedure described by CPT® Code 33019 involves the pericardial drainage with the insertion of an indwelling catheter using a percutaneous approach, which is guided by computed tomography (CT). The pericardial sac, a delicate two-layer membrane encasing the heart, typically contains a small volume of fluid that serves to minimize friction during heartbeats. However, various conditions such as infections, malignancies, inflammation, injuries, adverse drug reactions, or metabolic disorders can lead to an accumulation of excess fluid, known as pericardial effusion. This excess fluid can exert pressure on the heart, potentially compromising its function. To alleviate this condition, a pericardial drainage procedure is performed. This minimally invasive technique is conducted under local anesthesia, where a needle is carefully inserted through the chest wall into the pericardial space. The needle is advanced through the outer layer of the pericardial sac into the fluid-filled cavity. Once the needle is in place, a thin, flexible catheter is threaded through it and into the pericardial sac, after which the needle is removed. The catheter is then secured to the chest wall using sutures or tape to prevent displacement. Fluid can be aspirated from the pericardial sac either initially with a syringe connected to the catheter or by attaching the catheter to a drainage bag for continuous drainage. The procedure may utilize various imaging modalities for guidance, including ultrasound, fluoroscopy, or CT. Ultrasound guidance requires direct contact with the skin, which may not be feasible in patients with recent cardiothoracic surgeries due to potential obstructions from incisions or dressings. Fluoroscopic guidance, while not requiring skin contact, may lack the necessary field of view or spatial resolution. In contrast, CT guidance offers superior visualization of the thoracic and cardiac anatomy, making it particularly useful for complex cases involving the pericardial sac. CPT® Code 33019 specifically denotes the use of CT guidance for this procedure, distinguishing it from other codes that may involve fluoroscopic or ultrasound guidance.
© Copyright 2025 Coding Ahead. All rights reserved.
The pericardial drainage procedure is indicated for patients experiencing pericardial effusion, which can arise from various underlying conditions. The following are specific indications for performing this procedure:
The pericardial drainage procedure involves several critical steps to ensure safe and effective fluid removal from the pericardial sac:
After the pericardial drainage procedure, patients are typically monitored for any complications or adverse effects. The catheter may remain in place for a period to allow for continuous drainage of fluid, depending on the clinical situation. Patients may be advised to avoid strenuous activities and to report any signs of infection, such as fever or increased pain at the insertion site. Follow-up imaging may be necessary to assess the effectiveness of the drainage and to monitor for any recurrence of fluid accumulation. Proper documentation of the procedure and any fluid analysis performed is essential for ongoing patient management and care.
| Short Descr | PERQ PRCRD DRG INSJ CATH CT | Medium Descr | PERQ PERICARDIAL DRG W/INSJ NDWELLG CATH W/CT | Long Descr | Pericardial drainage with insertion of indwelling catheter, percutaneous, including CT guidance | 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 |
| X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | 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). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period |
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| 2020-01-01 | Added | Code added. |
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