How To Use CPT Code 33957

CPT 33957 describes the repositioning of a peripheral cannula in a child from birth through five years of age for extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) procedures. 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 33957?

CPT 33957 can be used to describe the repositioning of a peripheral cannula in a child from birth through five years of age for ECMO or ECLS procedures. This code is used when a physician repositions the cannula through a percutaneous incision, with the assistance of fluoroscopic guidance, to perform extracorporeal circulation in a young patient.

2. Official Description

The official description of CPT code 33957 is: ‘Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age (includes fluoroscopic guidance, when performed).’

3. Procedure

1. The physician prepares the patient for the procedure, ensuring appropriate anesthesia and prepping the area of the peripheral cannula insertion.
2. The physician accesses the peripheral arterial and/or venous cannula percutaneously, typically through the femoral or other vein or artery.
3. The physician cleans the area around the vessel and repositions the peripheral cannula into the open end of the vessel.
4. Using fluoroscopic guidance, the physician carefully and slowly repositions the cannula to ensure proper placement.
5. The physician connects the cannula to an external device, such as an artificial lung or oxygenator, which actively pumps and oxygenates the blood.
6. A heat exchanger may be used to warm the blood to body temperature before returning it to the patient through the cannula.
7. The physician closes the percutaneous incision with sutures.

4. Qualifying circumstances

CPT 33957 is used for children from birth through five years of age who require ECMO or ECLS procedures. The repositioning of the peripheral cannula is performed by a physician and includes the use of fluoroscopic guidance. This code is specific to this age group and procedure.

5. When to use CPT code 33957

CPT code 33957 should be used when a physician repositions a peripheral cannula in a child from birth through five years of age for ECMO or ECLS procedures. It is important to ensure that the patient falls within the specified age range and that the procedure involves the repositioning of the cannula using a percutaneous approach with fluoroscopic guidance.

6. Documentation requirements

To support a claim for CPT 33957, the physician must document the following information:

• Patient’s age and indication for ECMO or ECLS
• Details of the repositioning procedure, including the specific vessels accessed and the use of fluoroscopic guidance
• Date and duration of the procedure
• Any complications or additional interventions performed
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 33957, ensure that the procedure is performed by a physician and involves the repositioning of a peripheral cannula in a child from birth through five years of age for ECMO or ECLS procedures. Use the appropriate CPT code based on the age of the patient and the specific procedure performed. It is important to follow any additional guidelines or requirements set forth by the payer or coding guidelines.

8. Historical information

CPT 33957 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.

9. Examples

1. A physician repositions a peripheral cannula in a two-year-old child for ECMO support.
2. A surgeon performs the repositioning of a peripheral cannula in a newborn for ECLS procedures.
3. A pediatric cardiologist repositions a peripheral cannula in a four-year-old child for ECMO support during cardiac surgery.
4. An interventional radiologist repositions a peripheral cannula in a three-year-old child for ECLS procedures due to respiratory failure.
5. A cardiothoracic surgeon performs the repositioning of a peripheral cannula in a five-year-old child for ECMO support following a heart transplant.
6. A pediatric intensivist repositions a peripheral cannula in a premature infant for ECLS procedures due to severe respiratory distress.
7. A pediatric anesthesiologist repositions a peripheral cannula in a one-year-old child for ECMO support during a complex cardiac procedure.
8. A pediatric surgeon performs the repositioning of a peripheral cannula in a three-month-old infant for ECLS procedures following a traumatic injury.
9. An interventional radiologist repositions a peripheral cannula in a two-year-old child for ECMO support due to septic shock.
10. A pediatric cardiothoracic surgeon repositions a peripheral cannula in a five-year-old child for ECLS procedures during a complex congenital heart defect repair.