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"An incision was made over the xiphoid process and dissection was carried down to the level of the xiphoid, which was dissected free and excised. The inferior aspect of the sternum was then elevated, and the pericardium was opened under direct visualization. The pericardiotomy was extended medially and laterally to allow for placement of the convergent cannula. A 5 mm scope was passed thru the cannula and the heart was examined. There was a moderate amt of epicardial fat present in the left atrium. There were some moderate adhesions over by the pulmonary veins. The ablations were begun. A total of 16 were completed, which appeared to cover the majority of the posterior wall of the left atrium. Some adhesions were taken down. A 24 French Blake drain was placed and fascia, subQ, skin was closed."

We are having a hard time determining if this would be 33254 since he excised the xiphoid and visualized the pericardium or if 33265 is more appropriate since a scope was utilized. Thank you.