How To Use CPT Code 33018

CPT 33018 describes the pericardial drainage procedure with the insertion of an indwelling catheter, performed percutaneously with the guidance of fluoroscopy and/or ultrasound. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 33018?

CPT 33018 is used to describe a pericardial drainage procedure in which a qualified healthcare provider inserts a catheter through the chest wall to drain fluid from around the heart. This procedure is performed on patients who are newborn up through 5 years of age or any patient of any age with a congenital cardiac anomaly. The provider uses fluoroscopy and/or ultrasound guidance to ensure accurate needle placement and assess the congenital cardiac anomaly.

2. Official Description

The official description of CPT code 33018 is: ‘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.’

3. Procedure

1. The healthcare provider prepares the patient and selects a site between the xiphoid process and the left sternocostal margin.
2. A small incision may be made to reduce needle resistance.
3. The provider advances a needle attached to a syringe or suction device into the pericardial space, using fluoroscopic or ultrasound imaging guidance.
4. Once the proper location is identified, the provider aspirates fluid from the pericardial sac into the syringe.
5. The provider withdraws the needle and inserts a catheter through the same puncture site, leaving it indwelling for continued drainage.

4. Qualifying circumstances

CPT 33018 is performed on patients who are newborn up through 5 years of age or any patient of any age with a congenital cardiac anomaly. It is used to relieve pericardial effusion or cardiac tamponade, as well as for diagnostic, palliative, or prophylactic purposes. The procedure requires the use of fluoroscopy and/or ultrasound guidance.

5. When to use CPT code 33018

CPT code 33018 should be used when performing pericardial drainage with the insertion of an indwelling catheter on patients who are newborn up through 5 years of age or any patient of any age with a congenital cardiac anomaly. It should not be reported in conjunction with codes 75989, 76942, 77002, 77012, or 77021. Additionally, it should not be reported in conjunction with codes 93303-93325 when echocardiography is performed solely for the purpose of pericardiocentesis guidance.

6. Documentation requirements

To support a claim for CPT 33018, the healthcare provider must document the following information:

• Patient’s age and presence of a congenital cardiac anomaly
• Procedure details, including the use of fluoroscopy and/or ultrasound guidance
• Date and duration of the procedure
• Fluid aspirated from the pericardial sac
• Insertion of the indwelling catheter
• Any additional relevant information or findings

7. Billing guidelines

When billing for CPT 33018, ensure that the procedure is performed on patients who are newborn up through 5 years of age or any patient of any age with a congenital cardiac anomaly. The use of fluoroscopy and/or ultrasound guidance is included in this code and should not be reported separately. It should not be reported in conjunction with codes 75989, 76942, 77002, 77012, or 77021. Additionally, it should not be reported in conjunction with codes 93303-93325 when echocardiography is performed solely for the purpose of pericardiocentesis guidance.

8. Historical information

CPT 33018 was added to the Current Procedural Terminology system on January 1, 2020. It was also added to the Inpatient Only (IPO) list for Medicare in 2020.

9. Examples

1. A qualified healthcare provider performs pericardial drainage with the insertion of an indwelling catheter on a newborn patient with a congenital cardiac anomaly.
2. A healthcare provider uses fluoroscopy and ultrasound guidance to perform pericardial drainage with the insertion of an indwelling catheter on a 3-year-old patient with pericardial effusion.
3. During a pericardial drainage procedure, a healthcare provider aspirates fluid from the pericardial sac and inserts an indwelling catheter in a 5-year-old patient with cardiac tamponade.
4. A qualified healthcare provider performs pericardial drainage with the insertion of an indwelling catheter on an adult patient with a congenital cardiac anomaly.
5. Using fluoroscopy and ultrasound guidance, a healthcare provider drains fluid from the pericardial sac and inserts an indwelling catheter in a 40-year-old patient with pericardial effusion.
6. During a pericardial drainage procedure, a healthcare provider aspirates fluid from the pericardial sac and inserts an indwelling catheter in a 60-year-old patient with cardiac tamponade.