How To Use CPT Code 33951

CPT 33951 describes the insertion of peripheral cannula(e) in a child from birth through five years of age for extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS). 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 33951?

CPT 33951 is used to describe the insertion of peripheral cannula(e) in a child from birth through five years of age for extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS). This procedure is typically performed when a child has cardiopulmonary insufficiency, a condition where there is a disruption in blood circulation in the heart and pulmonary vessels, leading to decreased oxygen saturation in the blood and potential heart failure. The insertion of peripheral cannula(e) allows for the initiation of extracorporeal circulation, which provides oxygenation and carbon dioxide exchange outside of the body.

2. Official Description

The official description of CPT code 33951 is: ‘Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age (includes fluoroscopic guidance, when performed).’ This code specifically applies to the insertion of peripheral cannula(e) in a child from birth through five years of age for ECMO or ECLS, and it includes the use of fluoroscopic guidance if performed.

3. Procedure

1. The provider prepares the patient for the procedure, ensuring appropriate anesthesia and patient positioning.
2. The provider accesses the peripheral artery or vein percutaneously, typically through the femoral or another vessel.
3. Using fluoroscopic guidance, the provider inserts a peripheral cannula into the vessel, creating an exit point for oxygen-depleted blood from the body.
4. If a double-lumen catheter is used, the provider also places a return cannula through the same vessel to allow for the return of oxygenated blood.
5. The provider connects the cannula(e) to an extracorporeal circulation device, which actively pumps blood through an external oxygenator for gas exchange.
6. A heat exchanger may be used to warm the blood to body temperature before returning it to the patient through the cannula(e).
7. Once the procedure is complete, the provider closes the incision with sutures.

4. Qualifying circumstances

CPT 33951 is performed on children from birth through five years of age who require ECMO or ECLS for cardiopulmonary insufficiency. The procedure involves the insertion of peripheral cannula(e) into the arterial and/or venous vessels, typically through the femoral or another vessel. Fluoroscopic guidance may be used during the procedure to ensure accurate placement of the cannula(e).

5. When to use CPT code 33951

CPT code 33951 should be used when a physician inserts peripheral cannula(e) in a child from birth through five years of age for ECMO or ECLS. This code is specific to this age group and procedure. It should not be used for patients older than five years of age or for other procedures involving ECMO or ECLS.

6. Documentation requirements

To support a claim for CPT 33951, the provider must document the following information:

• Patient’s age and indication for ECMO or ECLS
• Specific vessels accessed and cannula insertion sites
• Use of fluoroscopic guidance, if performed
• Details of the procedure, including any complications or additional interventions
• Start and end times of the procedure
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 33951, ensure that the procedure is performed by a physician and involves the insertion of peripheral cannula(e) in a child from birth through five years of age for ECMO or ECLS. The code includes fluoroscopic guidance, if performed. It is important to follow any specific billing guidelines provided by the payer or coding guidelines. Additionally, be aware of any bundling or unbundling rules that may apply to this procedure.

8. Historical information

CPT 33951 was added to the Current Procedural Terminology system on January 1, 2015. It has not undergone any updates since its addition. In 2017, it was added to the Inpatient Only (IPO) list for Medicare reimbursement purposes.

9. Examples

1. A physician inserts peripheral cannula(e) in a two-year-old child for ECMO due to severe cardiopulmonary insufficiency.
2. Using fluoroscopic guidance, a physician performs the insertion of peripheral cannula(e) in a newborn for ECLS to support heart and lung function.
3. A five-year-old child with heart failure undergoes the insertion of peripheral cannula(e) for ECMO under the care of a physician.
4. For a three-year-old child with pulmonic regurgitation, a physician performs the insertion of peripheral cannula(e) for ECLS to provide cardiopulmonary support.
5. Using fluoroscopic guidance, a physician inserts peripheral cannula(e) in a four-year-old child for ECMO to address cardiopulmonary insufficiency.
6. A physician performs the insertion of peripheral cannula(e) in a one-year-old child for ECLS to support heart and lung function.