# Pericardiocentesis



## shescka (Mar 19, 2015)

Hello 
I need help, my Dr. is using 32659, 33010 to code his pericardiocentesis procedures. I coded this one as 93458,26  33010 alone, please let me know if I'm right or lost 
Thank you in advance


Procedure(s):
LEFT HEART CATHETERIZATION WITH POSSIBLE INTERVENTION/ PERICARDIOCENTESIS
Laterality / Access Site:  Right Femoral Artery
Implant(s): None
Clinical Indications:  Non ST elevation MI and large pericardial effusion. 


Description of procedure #1: LHC

Informed consent signed and placed in chart  

Patient was premedicated for iodine allergy

Patient transferred to cath lab room  

Prepped and draped in usual sterile fashion  

2% lidocaine in right groin  

Micropuncture needle used for access right common femoral artery with the Seldinger technique  

Micropuncture canula placed  

Right iliofemoral angiogram performed, adequate access confirmed  

J wire advanced  

Micropuncture canula exchanged for a 4-FR sheath  

4-FR JL4, 3DRC, Pigtail catheters advanced over the wire  

Multiple orthogonal angiogram obtained and reviewed  

Procedure finished, patient stable, transferred to recovery where the sheath will be removed and manual compression used for hemostasis. 

Findings #1: LHC

1. Left main: Normal.

2. LAD: 40-50% focal stenosis mid segment.

3. Left circumflex coronary artery: Normal.

4. Right coronary artery: Dominant. 30% focal stenosis proximal.

5. LVgram: deferred. LVEDP: 25 mmHg. No gradient across the aortic valve on pullback.


Procedure #2: Pericardiocentesis.

Prepped and draped in usual sterile fashion  

2% lidocaine in subxiphoid area

Using the pericardiocentesis needle and under fluoroscopy the pericardial cavity was accessed.

Opening pressure 15 mmHg

Pericardiocentesis catheter advanced over the wire and left in placed

Aproximately 700 cc of bloody fluid were drained and sent for multiple studies.

Catheter left in placed, sutured to the skin

Pressure after draining fluid 4 mmHg  


Complications:  none
Estimated Blood Loss:   10 cc
Post Operative Condition: Stable
Disposition:  Floor


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## ccollison (Mar 20, 2015)

I agree with your codes. 36259 is not appropriate in this case as it is for a creation of pericardial window or partial resection of pericardial sac for drainage.  The note does not support 36259. 
C Collison CPPM, CCC


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## j.monday7814 (Mar 23, 2015)

ccollison said:


> I agree with your codes. 36259 is not appropriate in this case as it is for a creation of pericardial window or partial resection of pericardial sac for drainage.  The note does not support 36259.
> C Collison CPPM, CCC


yep, I agree as well. he did not create a pericardial window, just an aspiration pericardiocentesis and the full CCLV.


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## shescka (Mar 26, 2015)

*thank you*

Many thanks to you both


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