Cardiology Coding Alert

Question: How should I report an emergency pericardiocentesis that the cardiologist performed in the hospital?

Nevada Subscriber

Answer: In this case, you would choose 33010 (Pericardio­centesis; initial).

When excess fluid builds up between the two layers that make up the pericardial sac, the tissue surrounding the heart, pericardial effusion can occur, impacting the heart’s normal functions. During pericardiocentesis, the physician inserts a needle to remove this extra fluid from the pericardial sac. Once the physician places the needle inside the pericardium, he uses a catheter to drain the fluid.

Conditions that cause pericardial effusion include but are not limited to infection of the heart or pericardial sac, cancer, inflammation of the pericardial sac due to a heart attack, injury, and immune system disease.

The physician will typically perform an ultrasound with the pericardiocentesis, and to report this procedure, you would use 76930 (Ultrasonic guidance for pericardiocentesis, imaging supervision and interpretation). Because the procedure occurred in a hospital, be sure to append modifier 26 (Professional component) to 76930 to indicate you’re not reporting the technical component.

Important: CPT^® revised 33010 in 2017 by unbundling moderate (conscious) sedation from the procedure. Now, since using moderation sedation is no longer considered an inherent part of pericardiocentesis, you can separately report sedation that your provider performs.

When the same physician or other qualified healthcare professional performs both the moderate sedation and the pericardiocentesis, turn to 99151, 99152, and +99153 (Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status …).

On the other hand, when a different physician or other qualified healthcare professional performs the moderate sedation and the pericardiocentesis, that provider will choose from 99155, 99156, and +99157 (Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports ...).