# Tube pericardiostomy



## geigert (May 16, 2012)

Hi,
My doctor did a Tube Pericardiostomy and I am unsure of what radiology codes to use with that.  I know the main code is 33015 but then should I use 76930-26 or 75989-26 or 77002-26 for the fluoroscopic gudance?  Also, if I bill one of the 7____ codes, can I also bill the 93308-26 Limited Echo?

PERICARDIOCENTESIS SUMMARY:
The patient was placed in a supine position on the cardiac catheterization
laboratory table.  The left anterior chest was prepped and draped in a sterile
fashion.  Echocardiography was performed to determine the optimal site and
trajectory for pericardiocentesis.

Local anesthesia was provided in the left anterior chest area inferior to the left
nipple.  An 18 gauge needle was used to enter the pericardial space with the needle
directed posterolateral to the left ventricle.  Using fluoroscopic guidance, a 0.035
inch J tip wire was advanced through the needle and positioned posterior to the left
ventricle.  An 8.3 French pigtail catheter was advanced into the pericardial space. 
The fluid was aspirated manually with removal of 1,250 mL of sanguineous,
non clotting fluid.  The effusion was aspirated completely.  The pigtail catheter
was attached to a JP suction bulb.  The catheter was secured to the anterior chest
using 2 Stat Lock devices.  The site was dressed with a sterile dressing.

The pericardial effusion was sent for diagnostic studies to include cytology, cell
count, transudate/exudate studies, and cultures for general bacteria, fungi, and
tuberculosis.

LIMITED ECHOCARDIOGRAM:
Echocardiography was performed with 2 dimensional imaging to assess the
circumferential pericardial effusion and to determine the optimum site and
trajectory for needle insertion.  An apical window was selected.  The pericardial
effusion was large, with right atrial and right ventricular compression.  Rhythm 
analysis showed electrical alternans.

Limited echocardiography was repeated during pericardiocentesis and following
complete drainage of the effusion.  The echo confirmed position of the pigtail
catheter posterolateral to the left ventricle.  The effusion was aspirated
completely, with resolution of tamponade and electrical alternans.

CARDIAC FLUOROSCOPY:
Cardiac fluoroscopy was utilized to guide placement of the pericardiocentesis needle
and guidewire.  Placement of the pericardiostomy tube was confirmed with fluoroscopy
and cine angiography.

The procedure was well tolerated.

Any thoughts would be appreciated.  Thanks.


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