How To Use CPT Code 33953

CPT 33953 describes the insertion of peripheral (arterial and/or venous) cannula(e) for extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) in a child from birth through 5 years of age. 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 33953?

CPT 33953 is used to describe the insertion of peripheral cannula(e) for extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) in a child from birth through 5 years of age. This procedure involves the surgical placement of a cannula through an open approach to establish extracorporeal circulation, which allows for the oxygenation of blood outside of the body.

2. Official Description

The official description of CPT code 33953 is: ‘Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age.’

3. Procedure

1. The provider prepares the patient for the procedure, ensuring appropriate anesthesia and positioning.
2. An incision is made over the femoral or other vein or artery.
3. The area around the vessel is cleaned to maintain a sterile environment.
4. A cannula is inserted into the open end of the vessel, allowing for the exit of oxygen-depleted blood from the body.
5. Depending on the type of cannula used, the blood may return through the same cannula or a separate cannula is inserted for the return of oxygenated blood.
6. The provider connects the cannula to an extracorporeal circulation device, which pumps the blood through an external device called an oxygenator for gas exchange.
7. A heat exchanger is used to warm the blood to body temperature before it is returned to the patient through the cannula.
8. The incision is closed with sutures.

4. Qualifying circumstances

CPT 33953 is performed on children from birth through 5 years of age who require extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS). This procedure is typically indicated for patients with severe respiratory or cardiac failure who are unresponsive to conventional therapies. The insertion of peripheral cannula(e) allows for the establishment of extracorporeal circulation, providing oxygenation and carbon dioxide removal outside of the body.

5. When to use CPT code 33953

CPT code 33953 should be used when a physician performs the insertion of peripheral cannula(e) for extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) in a child from birth through 5 years of age. This code is specific to the age range mentioned and should not be used for patients older than 5 years. It is important to accurately document the patient’s age to ensure proper coding and billing.

6. Documentation requirements

To support a claim for CPT 33953, the following documentation is required:

• Patient’s age (birth through 5 years)
• Procedure performed (insertion of peripheral cannula(e) for ECMO/ECLS)
• Specific vessels accessed (femoral or other vein/artery)
• Details of the procedure, including any fluoroscopic guidance used
• Use of a standardized technique for cannula insertion
• Confirmation of successful cannula placement
• Use of an extracorporeal circulation device and oxygenator
• Duration of the procedure
• Incision closure method
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 33953, ensure that the procedure is performed by a physician and that the patient falls within the specified age range (birth through 5 years). It is important to accurately document the details of the procedure and meet the necessary documentation requirements. CPT code 33953 should not be reported with other codes for the maintenance of extracorporeal circulation. It is also important to consider the location of the testing and use the appropriate modifiers for professional and technical components, if applicable.

8. Historical information

CPT code 33953 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. There have been no updates to the code since its addition.

9. Examples

1. A physician inserts peripheral cannula(e) for extracorporeal membrane oxygenation (ECMO) in a newborn with severe respiratory failure.
2. A surgeon performs the insertion of peripheral cannula(e) for extracorporeal life support (ECLS) in a 3-year-old child with cardiac failure.
3. A pediatric cardiologist places peripheral cannula(e) for extracorporeal membrane oxygenation (ECMO) in a 2-year-old patient with congenital heart disease.
4. An anesthesiologist performs the insertion of peripheral cannula(e) for extracorporeal life support (ECLS) in a 4-year-old child undergoing cardiac surgery.
5. A cardiothoracic surgeon inserts peripheral cannula(e) for extracorporeal membrane oxygenation (ECMO) in a 5-year-old patient with severe respiratory distress.