How To Use CPT Code 33952

CPT 33952 describes the insertion of peripheral (arterial and/or venous) cannula(e) by a physician for extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) in patients aged six years and older. 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 33952?

CPT 33952 is used to describe the procedure in which a physician inserts peripheral cannula(e) through a percutaneous incision for extracorporeal circulation in patients aged six years and older. This procedure is typically performed on patients with 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 the cannula(e) is guided by fluoroscopy, which provides real-time X-ray images of the body structures.

2. Official Description

The official description of CPT code 33952 is: ‘Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older (includes fluoroscopic guidance, when performed)’

3. Procedure

1. The physician prepares the patient and administers anesthesia.
2. The physician makes a percutaneous incision and accesses the peripheral artery or vein.
3. The area around the femoral or other vein or artery is cleaned.
4. The physician inserts the peripheral cannula into the open end of the vessel.
5. The cannula is slowly inserted through the femoral or another vessel, serving as an exit point for oxygen-depleted blood.
6. If a double-lumen catheter is used, the blood may return through the same cannula. If a single-lumen catheter is used, the physician creates a means for the return of oxygenated blood.
7. The physician places the return cannula through the femoral or another vessel.
8. The extracorporeal circulation device actively pumps the blood through the oxygenator in the external device, where gas exchange occurs.
9. A heat exchanger warms the blood to body temperature before returning it to the patient through the cannula.
10. The physician closes the incision with sutures.

4. Qualifying circumstances

CPT 33952 is performed on patients aged six years and older who require extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) due to cardiopulmonary insufficiency. The procedure involves the insertion of peripheral cannula(e) through a percutaneous incision, with fluoroscopic guidance if necessary.

5. When to use CPT code 33952

CPT code 33952 should be used when a physician performs the insertion of peripheral cannula(e) for extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) in patients aged six years and older. It is important to ensure that the procedure includes the use of fluoroscopic guidance, if performed.

6. Documentation requirements

To support a claim for CPT 33952, the physician must document the following information:

• Patient’s age (must be six years or older)
• Indication for extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS)
• Specific vessels accessed and cannula insertion sites
• Use of fluoroscopic guidance, if performed
• Details of the procedure, including any complications or additional steps taken
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 33952, ensure that the procedure is performed by a physician and includes the insertion of peripheral cannula(e) through a percutaneous incision. The use of fluoroscopic guidance, if performed, should also be documented. It is important to follow any specific billing guidelines provided by the payer or coding guidelines.

8. Historical information

CPT 33952 was added to the Current Procedural Terminology system on January 1, 2015. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A physician inserts peripheral cannulae through a percutaneous incision for extracorporeal membrane oxygenation (ECMO) in a 10-year-old patient with severe cardiopulmonary insufficiency.
2. Using fluoroscopic guidance, a physician performs the insertion of peripheral cannulae for extracorporeal life support (ECLS) in a 15-year-old patient with heart failure.
3. In a patient aged six years and older, a physician inserts peripheral cannulae through a percutaneous incision for extracorporeal membrane oxygenation (ECMO) due to pulmonic regurgitation.