Surgery: Cardiovascular System

CPT Assistant, November 2021, Volume 31, Issue 11, page 13

Question:

In the CPT 2021 code set, the parenthetical note for code 33025 states "Do not report 33020, 33025 in conjunction with 32551, if pleural drain/chest tube is placed on the ipsilateral side." In addition, the parenthetical note for code 32551 states "Do not report 32551 in conjunction with 33020, 33025, if pleural drain/chest tube is placed on the ipsilateral side." A surgeon performed a pericardial window and partial resection through a midline incision over the xiphoid. He placed drainage tubes into the pleura bilaterally through two separate stab incisions. In this clinical scenario, would it be appropriate to report code 32551 with modifiers 50 and 59 appended, based on the parenthetical notes in the CPT 2021 code set?

Answer:

Codes 33020, Pericardiotomy for removal of clot or foreign body (primary procedure), and 33025, Creation of pericardial window or partial resection for drainage, describe procedures that may be performed through a midline approach (eg, subxiphoid or median sternotomy). Alternatively, these procedures may also be performed via an anterolateral thoracotomy (most commonly left) approach. 

Codes 33020 and 33025 include the chest tube (32551) insertion on the ipsilateral side even if the chest tube is placed through a separate incision. A chest tube inserted on the left side as described in codes 33020 and 33025 should not be reported separately if the procedure is performed via a left anterolateral thoracotomy. If the procedures described by code 33020 or 33025 are performed via a subxiphoid or median sternotomy approach, the placement of a chest tube (32551), even if it is through a separate incision, is considered integral to the procedure and is, therefore, not separately reportable. If, however, a contralateral chest tube (most commonly right) for any of the approaches is required for a different diagnosis (eg, pleural effusion), that chest tube insertion may be separately reported with supporting documentation together with an appropriate unbundling modifier (eg, modifier 59, Distinct Procedural Service) and a different diagnosis code.