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The procedure described by CPT® Code 33050 involves the surgical resection of a pericardial cyst or tumor through an open approach. The pericardium, which is the fibrous membrane encasing the heart, can develop cysts or tumors that may require surgical intervention. During this procedure, the surgeon typically employs a median sternotomy or an anterolateral thoracotomy to gain access to the thoracic cavity and the heart. Once the thoracic cavity is opened, the surgeon inspects the area to locate the cyst or tumor. It is crucial to identify and protect the right and left phrenic nerves during the operation to prevent any complications. If the lesion is identified as a cyst, the surgeon may open it to evacuate any fluid and debris contained within. The next step involves carefully dissecting the cyst, tumor, or mass from the surrounding tissues and removing it along with a margin of healthy pericardium to ensure complete excision. After the resection, the defect in the pericardium may be addressed by either covering it with a synthetic patch or leaving it open to allow for drainage. In cases where the defect is left open, a chest tube is inserted into the defect, and an additional chest tube is placed in the pleural space to facilitate proper drainage and recovery.
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The procedure is indicated for the surgical removal of pericardial cysts or tumors that may cause symptoms or complications. The following conditions may warrant this intervention:
The surgical procedure for resection of a pericardial cyst or tumor involves several critical steps to ensure successful removal and patient safety. The first step is to perform a median sternotomy or anterolateral thoracotomy, which provides the necessary access to the thoracic cavity and the heart. Once the thoracic cavity is opened, the surgeon conducts a thorough inspection to locate the cyst or tumor. It is essential to identify the right and left phrenic nerves during this process, as these nerves must be protected to avoid postoperative complications. If a cyst is found, the surgeon may proceed to open it, allowing for the evacuation of any fluid and debris contained within. Following this, the cyst, tumor, or mass is carefully dissected from the surrounding tissues. This dissection is performed with precision to ensure that a margin of healthy pericardium is included with the excised lesion, which is crucial for preventing recurrence. After the complete removal of the cyst or tumor, the surgeon addresses the defect in the pericardium. This may involve covering the defect with a synthetic patch to promote healing or leaving it open to facilitate drainage. In cases where the defect is left open, a chest tube is inserted into the defect to allow for proper drainage, and an additional chest tube is placed in the pleural space to manage any fluid accumulation.
Post-procedure care following the resection of a pericardial cyst or tumor is critical for patient recovery. Patients are typically monitored in a postoperative setting for any signs of complications, such as bleeding or infection. The placement of chest tubes is essential for managing fluid drainage and preventing complications related to fluid accumulation in the thoracic cavity. Patients may experience discomfort or pain at the surgical site, which can be managed with appropriate analgesics. The recovery period may vary depending on the extent of the surgery and the patient's overall health. Follow-up appointments are necessary to assess healing and ensure that there are no signs of recurrence or complications. Additionally, patients may require imaging studies to monitor the surgical site and evaluate the effectiveness of the procedure.
| Short Descr | RESECT HEART SAC LESION | Medium Descr | RESECTION PERICARDIAL CYST/TUMOR | Long Descr | Resection of pericardial cyst or tumor | Status Code | Active Code | Global Days | 090 - Major Surgery | 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | 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) | P2F - Major procedure, cardiovascular-Other | MUE | 1 | CCS Clinical Classification | 49 - Other OR heart procedures |
This is a primary code that can be used with these additional add-on codes.
| 32674 | Add-on Code MPFS Status: Active Code APC C Thoracoscopy, surgical; with mediastinal and regional lymphadenectomy (List separately in addition to code for primary procedure) | 38746 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Thoracic lymphadenectomy by thoracotomy, mediastinal and regional lymphadenectomy (List separately in addition to code for primary procedure) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2012-01-01 | Changed | Description Changed |
| 2011-01-01 | Changed | Medium description changed. |
| Pre-1990 | Added | Code added. |
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