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pericardial effusion/hemopericardium help

  1. #1
    Default pericardial effusion/hemopericardium help
    Clearnace Sale
    Could someone please help me with the CPT coding on the following report? I am having problems finding the correct codes.

    Thank you in advance.

    1. Cardiac tamponade, pericardial effusion /hemopericardium.
    2. Cardiogenic shock.
    3. Coronary artery disease status post coronary bypass grafting.
    4. Left pleural effusion.
    1. Cardiac tamponade, pericardial effusion /hemopericardium.
    2. Cardiogenic shock.
    3. Coronary artery disease status post coronary bypass grafting.
    4. Left pleural effusion.
    1. Subxiphoid pericardial window/mediastinal reexploration.
    2. Left chest tube insertion.
    HISTORY OF PRESENT ILLNESS: The patient is a 61-year-old male who underwent
    coronary bypass grafting two weeks ago. He appears anticoagulated for atrial
    fibrillation. The patient developed a hemopericardium and is in tamponade
    with cardiogenic shock. The patient to the OR for emergency reexploration.
    OPERATIVE FINDINGS: The patient had a clotted hemopericardium, some free
    flowing blood, but a lot of it was just clot. Mostly it was down on top of
    the diaphragm and behind the left ventricle.
    OPERATIVE NOTE: The patient was brought in the OR, placed on the table in
    supine position. Appropriate monitoring devices were placed. He was
    intubated emergently. Femoral art line and central venous line were placed.
    He was quickly prepped and draped. The old incision was opened up down by the
    xiphoid. We opened it up, we had some bloody fluid coming out of the
    pericardium. We carefully evacuated clot down off on top of the diaphragm.
    This is where most it seemed to be located. Much of it was clot and had to be
    carefully removed. There was a vein graft down in the PDA and this area also
    had to be carefully avoided. There was not much clot up between the RV and the
    chest wall. I cannot find much clot out by the right atrium. I also used a
    30 degree 5 mm scope to help me to see. I did not open the sternum or remove
    the wires. Once I was satisfied with removal of the clot, I placed two Blake
    drains, one over the diaphragm and one anteriorly. We irrigated out with a
    copious amount of warm saline. A left pleural chest tube was then placed at
    about the seventh interspace in the mid axillary line. This returned some
    blood tinged fluid. We then closed the wound with a #1 Vicryl for the muscle
    layer, 2-0 Vicryl subcutaneous tissue and Monocryl for the skin. Dressing was
    applied. The patient was unstable at the beginning of the case but seemed to
    have improved by the end. At the beginning of the surgery, he was on
    high-dose dopamine and also started bleeding and started on neosynepherine.
    At the end, he was on 2 mcg of epinephrine only. Blood loss from the actual
    surgery was minimal. No specimen was sent.

  2. #2
    I'm going to assume this is the same provider who did the CABG, and I would go with 32120-78.

    I'm not actually seeing where they made a pericadial window, they say there is bloody fluid coming from the pericardium but I don't see them cutting into it. Unless I'm reading it wrong. Pericardial window for drainage is 33025 and based on my claim scrubber both codes can be billed together but based on what I am reading I would only go with the thoracotomy.

    Laura, CPC, CPMA, CEMC

  3. Default
    Since this is post-op hemorrhage and they went into the chest through the original incision, I would code 35820-78.

    Lisi, CPC

  4. #4
    Tarrant County, Fort Worth
    I have to agree, I would use 35820-78.

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