How To Use CPT Code 33946

CPT 33946 describes the initiation of extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) by a physician. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 33946?

CPT 33946 can be used to describe the initiation of extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) by a physician. This code is used when the physician inserts a cannula through a venovenous (VV) route to establish extracorporeal circulation, where the blood that drains from the venous system is returned to the venous system. This procedure is typically performed in patients experiencing lung failure, such as cardiopulmonary insufficiency or acute respiratory distress syndrome (ARDS), or in lung transplantation situations as a bridge to transplantation.

2. Official Description

The official description of CPT code 33946 is: ‘Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; initiation, veno-venous.’

3. Procedure

1. The physician prepares the patient and administers anesthesia.
2. An incision is made over the right jugular vein, and the area is cleaned.
3. A cannula is inserted into the open end of the vein and slowly advanced through the right jugular vein into the heart’s right atrium.
4. The cannula acts as an exit point for the oxygen-depleted blood from the body into an external device that functions as an artificial lung or oxygenator.
5. The extracorporeal circulation device actively pumps the blood through the oxygenator, where gas exchange occurs.
6. A heat exchanger warms the blood to body temperature before returning it to the patient through the cannula.
7. Once all cannulas are in position and secure, and flows are optimal, the incision is closed with sutures.

4. Qualifying circumstances

CPT 33946 is performed in patients with lung failure, such as cardiopulmonary insufficiency or acute respiratory distress syndrome (ARDS), or in lung transplantation situations as a bridge to transplantation. The procedure involves the insertion of a cannula through a venovenous (VV) route to establish extracorporeal circulation.

5. When to use CPT code 33946

CPT code 33946 should be used when a physician initiates extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) by inserting a cannula through a venovenous (VV) route. This code is specific to the initiation of the procedure and should not be used for other aspects of ECMO or ECLS.

6. Documentation requirements

To support a claim for CPT 33946, the physician must document the following information:

• Patient’s diagnosis and indication for ECMO/ECLS initiation
• Details of the procedure, including the specific cannula used and the route of insertion
• Date and time of the procedure
• Any complications or additional procedures performed
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 33946, ensure that the procedure is performed by a physician and involves the initiation of extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) through a venovenous (VV) route. Modifier 63 should not be reported in conjunction with CPT codes 33946, 33947, 33948, or 33949. It is important to review the specific billing guidelines of the payer to ensure accurate reporting and reimbursement.

8. Historical information

CPT 33946 was added to the Current Procedural Terminology system on January 1, 2015. It was later added to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A physician initiates extracorporeal membrane oxygenation (ECMO) for a patient with acute respiratory distress syndrome (ARDS) through a venovenous (VV) route.
2. A physician performs extracorporeal life support (ECLS) initiation for a patient with cardiopulmonary insufficiency using a cannula inserted through the right jugular vein.
3. A physician establishes extracorporeal circulation through a venovenous (VV) route as a bridge to lung transplantation for a patient with end-stage lung disease.
4. A physician initiates extracorporeal membrane oxygenation (ECMO) for a patient undergoing lung transplantation using a cannula inserted through the right jugular vein.
5. A physician performs extracorporeal life support (ECLS) initiation for a patient with severe lung failure using a venovenous (VV) route.
6. A physician establishes extracorporeal circulation through a venovenous (VV) route for a patient with refractory hypoxemia.
7. A physician initiates extracorporeal membrane oxygenation (ECMO) for a patient with severe respiratory failure using a cannula inserted through the right jugular vein.
8. A physician performs extracorporeal life support (ECLS) initiation for a patient with acute lung injury using a venovenous (VV) route.