How To Use CPT Code 33019

CPT 33019 describes the pericardial drainage procedure with the insertion of an indwelling catheter, performed percutaneously and including CT guidance. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 33019?

CPT 33019 is used to describe a pericardial drainage procedure with the insertion of an indwelling catheter. This procedure is performed percutaneously, meaning it is minimally invasive and done through the skin. It also includes CT guidance to ensure accuracy during the procedure.

2. Official Description

The official description of CPT code 33019 is: ‘Pericardial drainage with insertion of indwelling catheter, percutaneous, including CT guidance.’

3. Procedure

1. The provider selects a site between the xiphoid process and the left sternocostal margin.
2. A small incision may be made to reduce needle resistance.
3. A needle attached to a syringe or suction device is advanced into the pericardial space.
4. CT imaging guidance may be used to ensure accurate needle placement.
5. The provider aspirates fluid from the pericardial sac into the syringe.
6. The needle is withdrawn, and a catheter is inserted through the same puncture site.
7. The catheter is left indwelling for continued drainage in case fluid builds up again.

4. Qualifying circumstances

CPT 33019 is performed to relieve pericardial effusion or cardiac tamponade, as well as for diagnostic, palliative, or prophylactic purposes. It is typically done in patients without congenital cardiac anomalies who are 6 years old and older. The procedure requires CT guidance for accurate needle placement.

5. When to use CPT code 33019

CPT code 33019 should be used when performing a pericardial drainage procedure with the insertion of an indwelling catheter percutaneously and including CT guidance. It is important to note that this code should not be reported in conjunction with codes 75989, 76942, 77002, 77012, or 77021.

6. Documentation requirements

To support a claim for CPT 33019, the provider must document the following information:

• Patient’s diagnosis and the need for pericardial drainage
• Use of CT guidance during the procedure
• Date and duration of the procedure
• Specific details of the procedure, including the site of needle insertion and catheter placement
• Any complications or additional interventions performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 33019, ensure that the procedure meets the criteria described in the official description. It is important to note that CT guidance is included in this code and should not be reported separately. Additionally, be aware of the codes that should not be reported in conjunction with CPT 33019. For further guidance on reporting this code, refer to the official coding guidelines and any payer-specific requirements.

8. Historical information

CPT 33019 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 the same year.

9. Examples

1. A patient undergoes a pericardial drainage procedure with the insertion of an indwelling catheter, performed percutaneously and including CT guidance, to relieve pericardial effusion.
2. A provider performs a pericardial drainage procedure with the insertion of an indwelling catheter, performed percutaneously and including CT guidance, for diagnostic purposes in a patient with suspected cardiac tamponade.
3. During a pericardial drainage procedure with the insertion of an indwelling catheter, performed percutaneously and including CT guidance, a provider identifies and aspirates fluid from the pericardial sac in a patient with a history of pericardial effusion.
4. A pericardial drainage procedure with the insertion of an indwelling catheter, performed percutaneously and including CT guidance, is performed prophylactically in a patient at high risk for pericardial effusion.
5. A provider uses CT guidance during a pericardial drainage procedure with the insertion of an indwelling catheter, performed percutaneously, to ensure accurate needle placement in a patient with suspected cardiac tamponade.
6. During a pericardial drainage procedure with the insertion of an indwelling catheter, performed percutaneously and including CT guidance, a provider successfully relieves pericardial effusion in a patient with a history of heart disease.
7. A patient undergoes a pericardial drainage procedure with the insertion of an indwelling catheter, performed percutaneously and including CT guidance, to alleviate symptoms of cardiac tamponade.
8. A provider performs a pericardial drainage procedure with the insertion of an indwelling catheter, performed percutaneously and including CT guidance, for palliative purposes in a patient with advanced cancer.
9. During a pericardial drainage procedure with the insertion of an indwelling catheter, performed percutaneously and including CT guidance, a provider identifies and aspirates fluid from the pericardial sac in a patient with a recent history of pericardial effusion.