CPT® Code 33018

Pericardial drainage with insertion of indwelling catheter, percutaneous, including fluoroscopy and/or ultrasound guidance, when performed; birth through 5 years of age or any age with congenital cardiac anomaly

The procedure described by CPT® Code 33018 involves the pericardial drainage with the insertion of an indwelling catheter using a percutaneous approach. The pericardial sac, which is a thin, two-layer membrane encasing the heart, contains a small volume of fluid that serves to minimize friction during heartbeats. However, various conditions such as infections, malignancies, inflammation, injuries, drug reactions, or metabolic disorders can lead to an accumulation of excess fluid, known as pericardial effusion. This condition can significantly impair cardiac function. To alleviate this issue, a pericardial drainage procedure is performed, which may utilize imaging guidance techniques such as fluoroscopy, ultrasound, or computed tomography (CT) to ensure accurate placement of the catheter. During the procedure, local anesthesia is administered, and a needle is inserted through the chest wall into the pericardial space. The needle is carefully advanced through the outer membrane of the pericardial sac into the fluid-filled cavity. A flexible catheter is then threaded through the needle into the pericardial sac, after which the needle is removed. The catheter is secured to the chest wall using sutures and/or tape to prevent dislodgment. Once secured, the catheter allows for the aspiration of fluid, which can be done initially with a syringe or by connecting the catheter to a drainage bag for continuous drainage. It is important to note that ultrasound guidance requires direct skin contact with a probe, which may not be feasible in patients who have undergone recent cardiothoracic surgery due to potential obstructions from incisions or dressings. Conversely, fluoroscopic guidance does not necessitate contact but may lack the comprehensive field of view or detailed spatial resolution required for certain cases. CT guidance offers superior visualization of thoracic and cardiac structures, which can be particularly beneficial for complex procedures involving the pericardial sac. This code specifically applies to patients from birth through 5 years of age or any age with a congenital cardiac anomaly, distinguishing it from other related codes that cater to different age groups or conditions.