How To Use CPT Code 33947

CPT 33947 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 33947?

CPT 33947 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 veno-arterial (VA) route to establish extracorporeal circulation. This procedure is typically performed in patients experiencing severe heart failure or after cardiac or heart transplant surgeries.

2. Official Description

The official description of CPT code 33947 is: ‘Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; initiation, veno-arterial.’

3. Procedure

1. The physician makes an incision over the right jugular vein or common femoral vein and inserts a cannula into the vein.
2. The physician inserts a venous cannula into the inferior vena cava or right atrium to act as an exit point for oxygen-depleted blood.
3. An arterial cannula is placed into the right femoral artery to infuse oxygenated blood back into the patient.
4. The physician connects the cannulas to an external device that acts as an artificial lung or oxygenator.
5. The external 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 the cannulas are in position and secure, the physician closes the incision with sutures.

4. Qualifying circumstances

CPT 33947 is performed in patients with severe heart failure or after cardiac or heart transplant surgeries. The procedure involves the use of extracorporeal circulation to provide oxygen and carbon dioxide exchange, bypassing the heart and lungs. The physician inserts a cannula through a veno-arterial (VA) route to establish extracorporeal circulation.

5. When to use CPT code 33947

CPT code 33947 should be used when a physician initiates extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) through a veno-arterial (VA) route. This code is appropriate for patients experiencing severe heart failure or after cardiac or heart transplant surgeries.

6. Documentation requirements

To support a claim for CPT 33947, the physician must document the following information:

• Patient’s diagnosis and the need for ECMO/ECLS initiation
• Details of the procedure, including the location of the incision and placement of the cannulas
• Confirmation of successful establishment of extracorporeal circulation
• Any complications or additional procedures performed
• Signature of the physician performing the procedure

7. Billing guidelines

When billing for CPT 33947, 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 veno-arterial (VA) route. It is important to note that modifier 63 should not be reported in conjunction with CPT codes 33946, 33947, 33948, or 33949. Additionally, do not report CPT codes 33946 or 33947 in conjunction with CPT codes 33948, 33949, 33957, 33958, 33959, 33962, 33963, or 33964.

8. Historical information

CPT 33947 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) through a veno-arterial (VA) route for a patient with severe heart failure.
2. After a cardiac transplant surgery, a physician establishes extracorporeal life support (ECLS) using a cannula inserted through a veno-arterial (VA) route.
3. A patient undergoing a heart transplant surgery requires extracorporeal membrane oxygenation (ECMO) initiated by a physician through a veno-arterial (VA) route.
4. Following a severe heart failure episode, a physician performs extracorporeal life support (ECLS) initiation through a veno-arterial (VA) route for a patient.
5. A physician inserts a cannula through a veno-arterial (VA) route to initiate extracorporeal membrane oxygenation (ECMO) for a patient experiencing post-cardiac surgery complications.
6. After a heart transplant surgery, a physician establishes extracorporeal life support (ECLS) using a veno-arterial (VA) route to support the patient’s recovery.