Pericardiocentesis (Pericardial Aspiration / Pericardial Drain Placement) FAQ

CPT does not provide specific documentation requirements for a pericardiocentesis.

The medical record should clearly indicate that the procedure was performed, the indication for the procedure (e.g., tamponade physiology, large effusion),  the technique utilized (needle aspiration only vs. catheter left indwelling,) and identify the performing clinician.

33016 – Pericardiocentesis, including imaging guidance, when performed. 

33017 – Pericardial drainage with insertion of indwelling catheter, percutaneous, including fluoroscopy and/or ultrasound guidance, when performed; age ≥6 years without congenital cardiac anomaly. 

33018 – Same as 33017 but for birth–5 years, or any age with congenital cardiac anomaly. 

33019 – Pericardial drainage with insertion of indwelling catheter, percutaneous, including CT guidance. 

Note:  33017–33019 require that the catheter remain indwelling after the procedure per CPT guidance. 

No. Imaging guidance is included in the pericardial codes: 33016 includes imaging “when performed”; 33017/33018 include ultrasound and/or fluoroscopy; 33019 includes CT. Therefore, do not report separate guidance codes (e.g., 76942, 77002, 77012, 77021) for the same drainage. CMS’ 2025 NCCI manuals also illustrate that 76942 is bundled with 33016. If you perform a distinct diagnostic echocardiogram (not merely for needle guidance), you may report 93306/93308, but only with a separate indication, saved images, and an interpretation. 

Report only the definitive service. If you start with needle aspiration (33016) and then place an indwelling catheter, code only the appropriate drainage code (33017/33018/33019). This aligns with principles that a more comprehensive service includes the lesser service performed at the same encounter. 

Repeat on the same date: If a truly separate repeat pericardiocentesis/drain is required later the same day, append modifier -76 (same physician) or -77 (different physician) as appropriate and clearly document medical necessity. 

Unsuccessful/aborted attempt: If the procedure is started and discontinued due to extenuating circumstances or threat to patient well-being, append modifier -53 (Discontinued Procedure) with clear documentation of what was performed and why it was stopped. If you purposely reduce the service (e.g., partial aspiration by clinical choice), some payers may instruct use of -52 (Reduced Services). Expect reduced payment when using -52 or -53. 

Yes. Moderate (conscious) sedation is generally separately reportable when performed and documented. Use 99152 (initial 15 min, age ≥5, same physician) and +99153 (each additional 15 min; note: facility payment rules vary). If a different qualified professional provides the sedation, use 99156/99157. Document time, agents, monitoring, and continuous attendance.

No. Pericardiocentesis/pericardial drainage are separately billable in addition to critical care. Do not include time spent performing procedures in your critical care time tally. CMS reiterates that time devoted to separately reportable procedures must be excluded from critical care time. 

Yes. For percutaneous pericardial drainage with an indwelling catheter, choose by age/congenital status: 33018 for birth–5 years or any age with congenital cardiac anomaly; otherwise, 33017 for patients ≥6 years without congenital anomaly. Plain pericardiocentesis (33016) is not age-partitioned.