CPT 33025 Pericardial Window Reimbursement | OpenPayer

Summary & Overview

CPT 33025: Pericardial Window (Pericardiotomy)

CPT code 33025 identifies a surgical pericardial opening performed to drain pericardial fluid, commonly used to treat cardiac tamponade and other causes of clinically significant pericardial effusion. Nationally, this code represents an acute, often urgent surgical intervention with implications for hospital resource use, operative reporting, and insurer coverage policies.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical purpose of the code, typical sites of service (inpatient hospital/operating room), and the operational context for billing and claims submission. The publication also summarizes benchmarking and policy-relevant considerations that affect reimbursement and utilization reporting for acute cardiac surgical procedures.

This summary equips clinicians, coders, and payers with the clinical context for CPT code 33025, noting where to expect this service to appear on the claim and what stakeholders typically consider when evaluating coverage and payment for pericardial drainage procedures. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 33025pericardial windowpericardiotomycardiac surgeryprocedural codinginpatient surgeryoperative reportingpericardial effusioncardiac tamponade

Billing Code Overview

CPT code 33025 describes a surgical procedure in which the provider creates an opening in the pericardium to facilitate drainage of pericardial fluids. This service is a pericardial window or pericardiotomy performed to relieve cardiac tamponade or to enable ongoing drainage of fluid from the pericardial space.

Service type: Surgical procedure (pericardial drainage)
Typical site of service: Operative setting such as an inpatient hospital or operating room, or other procedural suite where surgical drainage of the pericardium is performed.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 62-year-old man presenting to the emergency department with progressive dyspnea, hypotension, and elevated jugular venous pressure. Echocardiography demonstrates a large pericardial effusion with early signs of cardiac tamponade. The cardiothoracic surgeon or interventional cardiologist is consulted. After hemodynamic stabilization and informed consent, the patient is taken to the cardiac catheterization laboratory or operating room. Under sterile conditions and with appropriate anesthesia (general or monitored anesthesia care), a subxiphoid pericardial window is created: the provider makes an incision, dissects to the pericardium, and creates an opening to allow drainage of pericardial fluid and to place a drain if required. Specimens of fluid may be sent for cytology, Gram stain/culture, and chemistry. The patient is monitored post-procedure in a step-down or intensive care setting for recurrent effusion, bleeding, infection, and hemodynamic recovery. Typical sites of service are the operating room, procedure room, or cardiac catheterization laboratory, with post-procedure recovery in PACU, ICU, or cardiac step-down unit. Common clinical indications include pericardial tamponade, large symptomatic pericardial effusion, malignant pericardial effusion requiring drainage, or purulent pericarditis requiring surgical drainage.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when substantial additional work beyond the usual is documented (e.g., extensive adhesiolysis, complex re-exploration).

CPT 33031: Pericardiectomy With Cardiopulmonary Bypass

CPT-33016-PERICARDIOCENTESIS-PERCUTANEOUS-DRAINAGE

CPT 33016: Percutaneous Pericardiocentesis with Imaging Guidance

CPT-33019-PERICARDIAL-DRAINAGE-WITH-INDWELLING-CATHETER

CPT 33019: Percutaneous Pericardial Drainage with Indwelling Catheter

CPT-33030-PERICARDIAL-TISSUE-REMOVAL-WITHOUT-CPB

CPT 33030: Removal of Damaged Pericardial Tissue Without Cardiopulmonary Bypass

CPT-33017-PERCUTANEOUS-PERICARDIAL-DRAINAGE-CATHETER

CPT 33017: Percutaneous Pericardial Drainage with Indwelling Catheter

CPT-33020-PERICARDIAL-CLOT-FOREIGN-BODY-REMOVAL

CPT 33020: Removal of Clot or Foreign Body from Pericardial Space

CPT-33050-PERICARDIAL-TUMOR-CYST-EXCISION

CPT 33050: Pericardial Tumor or Cyst Excision

CPT-33018-PERCUTANEOUS-PERICARDIAL-DRAINAGE-CATHETER-PLACEMENT-PEDIATRIC-CONGENITAL

CPT 33018: Percutaneous Pericardial Drainage with Indwelling Catheter

Taxonomy Code	Specialty	Notes
207RC0000X	Thoracic Surgery	Surgeons who perform pericardial window procedures and complex pericardial surgery.
207RP1001X	Cardiothoracic Vascular Surgery	Cardiac surgeons who perform open and minimally invasive pericardial drainage.
207RH0002X	Interventional Cardiology	Interventional cardiologists who may perform pericardiocentesis and surgical drainage in hybrid settings.
208800000X	Hospitalist/Internal Medicine	Hospitalists often manage pre- and post-procedure care, coordinate consults and inpatient care.
363L00000X	Emergency Medicine	Emergency physicians who identify tamponade and initiate urgent surgical consultation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I31.4`	Pericardial effusion (noninflammatory)	Direct indication for pericardial window when effusion is large or recurrent and symptomatic.
`I31.9`	Disease of pericardium, unspecified	Used when the specific pericardial diagnosis is not fully specified but surgical drainage is required.
`I31.0`	Tuberculous pericarditis	Infectious cause of pericardial effusion where surgical drainage and pericardial window may be required.
`I30.1`	Infective pericarditis	Purulent or severe infectious pericarditis can necessitate surgical drainage.
`I31.2`	Pericardial effusion in diseases classified elsewhere	Used when effusion is secondary to systemic disease (e.g., malignancy, autoimmune) requiring drainage.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33020`	Pericardiocentesis, including imaging guidance when performed; initial needle aspiration	Less invasive alternative to surgical pericardial window; often performed for diagnostic or therapeutic drainage prior to or instead of `33025`.
`33026`	Pericardiotomy with creation of a window by subxiphoid or thoracoscopic approach; with pericardial biopsy	Closely related surgical codes; `33026` may be reported when a pericardial biopsy is performed in conjunction with window creation.
`99291`	Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes	Used for pre- or post-procedure critical care management when the patient requires intensive support for tamponade or shock.
`32551`	Tube thoracostomy, includes insertion of chest tube for drainage (e.g., pleural effusion)	May be performed concurrently if thoracic drainage is required in addition to pericardial drainage.
`36556`	Placement of non-tunneled centrally inserted central venous catheter, age 5 years or older	Commonly performed for central access for vasoactive medications and monitoring during perioperative care.

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