How To Use CPT Code 33958

CPT 33958 describes the repositioning of a peripheral cannula through a percutaneous incision to perform extracorporeal circulation in a child 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 33958?

CPT 33958 can be used to describe the repositioning of a peripheral cannula through a percutaneous incision to perform extracorporeal circulation in a child six years and older. This code is used when the provider needs to adjust the position of the cannula to ensure proper functioning of the extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) device.

2. Official Description

The official description of CPT code 33958 is: ‘Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older (includes fluoroscopic guidance, when performed).’ This code should not be reported in conjunction with code 34713.

3. Procedure

1. The provider accesses the peripheral arterial and/or venous cannula percutaneously through a small incision.
2. The provider cleans the area around the vein or artery to reposition the peripheral cannula into the vessel.
3. The provider slowly repositions the cannula to ensure proper placement and functioning.
4. Fluoroscopic guidance may be used to assist the provider in visualizing the cannula and surrounding structures during the repositioning.
5. The provider uses an extracorporeal circulation device to actively pump the blood through the oxygenator in the external device, where gas exchange occurs.
6. A heat exchanger warms the blood to body temperature before returning it to the patient through the cannula.
7. The provider closes the incision with sutures.

4. Qualifying circumstances

CPT 33958 is performed on children six years and older who require repositioning of a peripheral cannula for extracorporeal circulation. This procedure is typically performed in cases where ECMO or ECLS is necessary to support the patient’s heart and lung function. The use of fluoroscopic guidance may be necessary to ensure accurate placement of the cannula.

5. When to use CPT code 33958

CPT code 33958 should be used when a provider repositions a peripheral cannula through a percutaneous incision in a child six years and older to perform extracorporeal circulation. This code should not be reported in conjunction with code 34713.

6. Documentation requirements

To support a claim for CPT 33958, the provider must document the following information:

• Reason for the repositioning of the peripheral cannula
• Details of the procedure, including the use of fluoroscopic guidance if applicable
• Date of the procedure
• Start and end time of the procedure
• Any complications or additional interventions performed
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 33958, ensure that the procedure is performed on a child six years and older and involves the repositioning of a peripheral cannula for extracorporeal circulation. Do not report CPT 33958 in conjunction with code 34713. It is important to follow the specific guidelines provided by the payer to ensure accurate and appropriate billing.

8. Historical information

CPT 33958 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 provider repositions a peripheral cannula through a percutaneous incision to perform extracorporeal circulation in a seven-year-old child with severe respiratory failure.
2. A provider uses fluoroscopic guidance to assist in the repositioning of a peripheral cannula for extracorporeal circulation in a nine-year-old child with cardiac arrest.
3. A provider performs the repositioning of a peripheral cannula in a six-year-old child undergoing ECMO for postoperative cardiac support.
4. A provider repositions a peripheral cannula in an eight-year-old child with acute respiratory distress syndrome requiring ECLS.
5. A provider uses fluoroscopic guidance to ensure accurate placement of the peripheral cannula during the repositioning procedure in a ten-year-old child with septic shock.
6. A provider performs the repositioning of a peripheral cannula in a twelve-year-old child with congenital heart disease undergoing ECMO for cardiac support.
7. A provider repositions a peripheral cannula through a percutaneous incision in a seven-year-old child with severe pneumonia requiring ECLS.
8. A provider uses fluoroscopic guidance to assist in the repositioning of a peripheral cannula for extracorporeal circulation in a nine-year-old child with acute respiratory failure.
9. A provider performs the repositioning of a peripheral cannula in a six-year-old child with sepsis and multiorgan failure requiring ECMO.
10. A provider repositions a peripheral cannula in an eight-year-old child with acute myocarditis undergoing ECLS for cardiac support.