How To Use CPT Code 33956

CPT 33956 describes the insertion of central cannula(e) by sternotomy or thoracotomy 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 33956?

CPT 33956 is used to describe the insertion of central cannula(e) through a sternotomy or thoracotomy approach for extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) in patients aged six years and older. This procedure involves the placement of a tube in the right jugular vein and the right carotid artery to facilitate the circulation of blood through an external device that acts as an artificial lung or oxygenator.

2. Official Description

The official description of CPT code 33956 is: ‘Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of central cannula(e) by sternotomy or thoracotomy, 6 years and older.’

3. Procedure

1. The patient is prepped and anesthetized.
2. The provider makes an incision over the breastbone or chest.
3. The area around the right jugular vein is cleaned.
4. A central cannula is inserted into the right jugular vein and advanced into the heart’s right atrium.
5. A return cannula is placed through the right carotid artery and advanced into the aorta.
6. An extracorporeal circulation device is used to pump the blood through an external device that acts as an artificial lung or oxygenator.
7. A heat exchanger warms the blood to body temperature before returning it to the patient through the cannula.
8. The incision is closed with sutures.

4. Qualifying circumstances

CPT 33956 is performed on patients aged six years and older who require extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS). This procedure is typically used in cases where the patient’s heart and lungs are unable to provide sufficient oxygenation and circulation. The insertion of central cannula(e) through a sternotomy or thoracotomy approach allows for the establishment of extracorporeal circulation to support the patient’s vital functions.

5. When to use CPT code 33956

CPT code 33956 should be used when a physician inserts central cannula(e) through a sternotomy or thoracotomy approach for extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) in patients aged six years and older. This code should not be reported in conjunction with codes 32100 or 39010. It is important to review the specific documentation and guidelines to determine the appropriate use of CPT code 33956.

6. Documentation requirements

To support a claim for CPT code 33956, the following documentation is required:

• Preoperative assessment and evaluation of the patient
• Description of the procedure performed, including the approach used (sternotomy or thoracotomy)
• Details of the central cannula insertion, including the specific veins and arteries accessed
• Use of extracorporeal circulation device and artificial lung or oxygenator
• Any additional procedures performed during the same operative session
• Postoperative care and management
• Signature of the performing physician

7. Billing guidelines

When billing for CPT code 33956, ensure that the procedure is performed by a physician and that the patient is aged six years and older. It is important to review the specific billing guidelines and requirements of the payer to ensure accurate reporting. CPT code 33956 should not be reported in conjunction with codes 32100 or 39010. It is also important to consider any applicable modifiers or additional documentation that may be required for proper reimbursement.

8. Historical information

CPT code 33956 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 further updates or changes to the code since its addition.

9. Examples

1. A physician performing the insertion of central cannula(e) through a sternotomy for extracorporeal membrane oxygenation (ECMO) in a 10-year-old patient with severe respiratory failure.
2. A surgeon inserting central cannula(e) through a thoracotomy approach for extracorporeal life support (ECLS) in a 40-year-old patient undergoing cardiac surgery.
3. A cardiothoracic surgeon performing the insertion of central cannula(e) through a sternotomy for extracorporeal membrane oxygenation (ECMO) in a 60-year-old patient with acute respiratory distress syndrome.
4. A pediatric cardiac surgeon inserting central cannula(e) through a thoracotomy approach for extracorporeal life support (ECLS) in a 7-year-old patient with congenital heart disease.
5. A cardiothoracic surgeon performing the insertion of central cannula(e) through a sternotomy for extracorporeal membrane oxygenation (ECMO) in a 50-year-old patient with cardiogenic shock.
6. A physician inserting central cannula(e) through a thoracotomy approach for extracorporeal life support (ECLS) in a 35-year-old patient with severe pulmonary hypertension.