How To Use CPT Code 33949

CPT 33949 describes the daily management of extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) provided by a physician. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 33949?

CPT 33949 can be used to describe the daily management services provided by a physician for patients who are on extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS). This code is used when the physician is responsible for the ongoing assessment, planning, and care of the patient who is on extracorporeal circulation.

2. Official Description

The official description of CPT code 33949 is: ‘Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; daily management, each day, veno-arterial.’

3. Procedure

1. After 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 conducts daily chest X-rays and laboratory tests.
3. Physical signs of perfusion and intravascular volume, including urine output and blood pressures, are closely monitored.
4. Head ultrasounds and neurologic exams are performed to assess the patient’s neurological status.
5. Hemoglobin, platelet levels, and clotting times are checked regularly.
6. Infection, fluids, electrolytes, and medication levels are monitored.

4. Qualifying circumstances

CPT 33949 is used for patients who require daily management of extracorporeal circulation through a veno-arterial (VA) route. This procedure is typically performed for patients with lung failure, such as cardiopulmonary insufficiency, acute respiratory distress syndrome (ARDS), or as a bridge to lung transplantation.

5. When to use CPT code 33949

CPT code 33949 should be used when a physician provides daily management services for a patient on ECMO or ECLS through a veno-arterial route. This code should be reported for each day of service provided to the patient.

6. Documentation requirements

To support a claim for CPT 33949, the physician must document the following information:

• Details of the patient’s condition and the need for ECMO or ECLS
• Documentation of the daily assessment and planning of care
• Monitoring of ventilator settings, positional changes, and endotracheal suctioning
• Results of daily chest X-rays and laboratory tests
• Monitoring of physical signs of perfusion and intravascular volume
• Assessment of neurological status through head ultrasounds and neurologic exams
• Monitoring of hemoglobin, platelet levels, and clotting times
• Documentation of infection control measures, fluid and electrolyte management, and medication levels

7. Billing guidelines

When billing for CPT 33949, ensure that the services are provided by a physician and that the daily management is for a patient on ECMO or ECLS through a veno-arterial route. It is important to follow the guidelines for reporting CPT code 33949 with other related codes. Modifier 63 should not be reported in conjunction with CPT codes 33946, 33947, 33948, or 33949. Additionally, CPT codes 33948 and 33949 should not be reported in conjunction with CPT codes 33946 or 33947.

8. Historical information

CPT code 33949 was added to the Current Procedural Terminology system on January 1, 2015. One historical change to note is that it was added to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A physician providing daily management services for a patient on ECMO for acute respiratory distress syndrome (ARDS).
2. A physician monitoring the ventilator, conducting daily chest X-rays, and assessing the patient’s neurological status for a patient on ECLS as a bridge to lung transplantation.
3. A physician closely monitoring hemoglobin, platelet levels, and clotting times for a patient on ECMO for cardiopulmonary insufficiency.
4. A physician assessing physical signs of perfusion and intravascular volume, and monitoring infection control measures for a patient on ECLS for lung failure.
5. A physician checking fluid and electrolyte levels, and assessing medication levels for a patient on ECMO for acute respiratory failure.
6. A physician performing daily chest X-rays and laboratory tests, and monitoring the patient’s response to ECMO for cardiogenic shock.
7. A physician conducting daily head ultrasounds and neurologic exams, and monitoring hemoglobin levels for a patient on ECLS for lung transplantation.