How To Use CPT Code 33948

CPT 33948 describes the daily management of extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) provided 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 33948?

CPT 33948 can be used to describe the daily management services provided by a physician for patients who are on venovenous (VV) ECMO or ECLS circulation. This code is used when the physician is responsible for the assessment, planning, and monitoring of care for patients who require extracorporeal circulation through a venovenous route.

2. Official Description

The official description of CPT code 33948 is: ‘Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; daily management, each day, veno-venous.’

3. Procedure

1. Following the insertion of the cannula and initiation of ECMO or ECLS, the physician performs daily assessment and planning of care for the patient.
2. The physician monitors the ventilator, positional changes, endotracheal suctioning, and daily chest X-rays and laboratory tests.
3. Physical signs of perfusion and intravascular volume, including urine output and blood pressures, are checked regularly.
4. Head ultrasounds and neurologic exams are conducted to assess the patient’s neurological status.
5. Hemoglobin, platelet levels, and clotting times are closely monitored.
6. Infection, fluids, and electrolytes are assessed, and medication levels are monitored.

4. Qualifying circumstances

CPT 33948 is used for patients who require daily management of ECMO or ECLS circulation through a venovenous route. This method is typically used for patients experiencing lung failure, such as cardiopulmonary insufficiency, acute respiratory distress syndrome (ARDS), or in lung transplantation situations as a bridge to transplantation. The physician must be responsible for the daily assessment, planning, and monitoring of care for the patient.

5. When to use CPT code 33948

CPT code 33948 should be used when a physician provides daily management services for patients on venovenous ECMO or ECLS circulation. This code represents each day of service for a patient with extracorporeal circulation through a venovenous route.

6. Documentation requirements

To support a claim for CPT 33948, the physician must document the following information:

• Insertion of the cannula and initiation of ECMO or ECLS
• Daily assessment and planning of care for the patient
• Monitoring of ventilator, positional changes, endotracheal suctioning, chest X-rays, and laboratory tests
• Physical signs of perfusion and intravascular volume
• Head ultrasounds and neurologic exams
• Hemoglobin, platelet levels, and clotting times
• Infection, fluids, and electrolytes assessment
• Medication levels monitoring

7. Billing guidelines

When billing for CPT 33948, ensure that the physician is providing daily management services for patients on venovenous ECMO or ECLS circulation. This code should not be reported with modifier 63 in conjunction with codes 33946, 33947, or 33949. It is important to consider the location of the testing and the use of modifiers when coding ECMO or ECLS services.

8. Historical information

CPT 33948 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 providing daily management services for a patient on venovenous ECMO for acute respiratory distress syndrome (ARDS).
2. A physician monitoring the ventilator, chest X-rays, and laboratory tests for a patient on venovenous ECLS for cardiopulmonary insufficiency.
3. A physician assessing physical signs of perfusion and intravascular volume for a patient on venovenous ECMO as a bridge to lung transplantation.
4. A physician conducting head ultrasounds and neurologic exams for a patient on venovenous ECLS for lung failure.
5. A physician closely monitoring hemoglobin, platelet levels, and clotting times for a patient on venovenous ECMO for lung transplantation.
6. A physician assessing infection, fluids, and electrolytes for a patient on venovenous ECLS for acute respiratory distress syndrome (ARDS).
7. A physician monitoring medication levels for a patient on venovenous ECMO for cardiopulmonary insufficiency.
8. A physician providing daily management services for a patient on venovenous ECLS as a bridge to lung transplantation.
9. A physician conducting daily chest X-rays and laboratory tests for a patient on venovenous ECMO for lung failure.
10. A physician assessing physical signs of perfusion and intravascular volume for a patient on venovenous ECLS for lung transplantation.