# Cpt code 33010



## nancy.anselmo@ccrheart.com (Mar 21, 2014)

Any help here wil be great, I don't want to make too many mistakes w/Medicare. Here is the report and since Medicare denied the 33010-26 
Billed the 1st time
33010-26 DENIED
93451-26-59
93308-26-59

Added codes, should I resubmit as
33010
76930-26-59
77002-26-59

ECHOCARDIOGRAM GUIDED PERICARDIOCENTESIS

INDICATIONS: Pericardial effusion and diastolic heart failure.

HISTORY OF PRESENT ILLNESS: The patient is a 67-year-old with a history of hypertension, obstructive sleep apnea who presented with atrial flutter in the setting of pericarditis. At that time have a small circumferential pericardial effusion. 
Anticoagulation was held. The patient was medically managed and reverted to sinus rhythm. He underwent coronary angiography that was clear obstructive disease. He had progressive symptoms of right-sided heart failure and shortness of breath. He 
incidentally received a CT scan at the behest of his urologist for evaluation and potential renal malignancy. In that CAT scan, it was observed that he had a large pericardial effusion. He underwent transthoracic echo that revealed a large 
circumferential pericardial effusion with equivocal signs of tamponade; however, most features were otherwise benign. The patient was hemodynamically stable. He was then set up for selective right heart catheterization with pericardiocentesis.

PROCEDURE: Informed consent was obtained; the patient understood the risks, benefits and alternatives to the procedure and agreed to proceed with the procedure. The patient was prepped and draped in sterile fashion and placed in the supine position. A
7-French sheath was then placed in the right common femoral vein for right heart catheterization; Swan-Ganz catheter was used. 

FINDINGS: The right atrial pressure was 25 mmHg. RV was 51/21 mmHg. PA was 58/28 with a mean PA of 37. Pulmonary capillary wedge pressure of 26. FA sat was 94%. PA sat of 54%. Fick cardiac output was 6.11 liters per minute. Based on relative 
equalization of diastolic pressures and echo evidence of significant effusion, it was elected to proceed with pericardiocentesis.

The patient was then placed on a wedge and subxiphoid area was prepped and draped in sterile fashion. Lidocaine was used for local anesthetic and pericardiocentesis needle was then inserted directly into the pericardium. A drain was then placed and 
then opening pressure of 25 mmHg consistent with hemodynamics and the right heart catheterization was observed and 1000 mL of serosanguineous fluid was drained. This was sent for cytology, cultures, AFB, total protein, glucose and cell count. At the 
conclusion of the procedure, an echo was free performed that demonstrated only limited residual circumferential effusion. The drain and sheaths were removed. No complications.

SUMMARY: Right heart catheterization with hemodynamic signature consistent with hemodynamic significant pericardial effusion. Successful pericardiocentesis with 1000 mL of serosanguineous fluid drained and sent for analysis.


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