How To Use CPT Code 33963

CPT 33963 describes the repositioning of central cannula(e) by sternotomy or thoracotomy in children from birth through 5 years of age. 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 33963?

CPT 33963 can be used to describe the repositioning of central cannula(e) in children from birth through 5 years of age. This code is used when a physician repositions the central cannula(e) through an open approach, either by sternotomy or thoracotomy, to ensure proper extracorporeal circulation.

2. Official Description

The official description of CPT code 33963 is: ‘Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age (includes fluoroscopic guidance, when performed)’

3. Procedure

1. The physician prepares the patient for the procedure and makes an incision over the breastbone or chest.
2. The area around the right jugular vein is cleaned to reposition the central cannula into the open end of the vein.
3. The physician slowly repositions the cannula through the right jugular vein into the heart’s right atrium.
4. The central cannula serves as an exit point for oxygen-depleted blood from the body into an external device acting as an artificial lung or oxygenator.
5. Fluoroscopic guidance may be used to assist the physician during the procedure.
6. The extracorporeal circulation device actively pumps the blood through the oxygenator, where gas exchange occurs, and warms the blood to body temperature before returning it to the patient through the cannula.
7. The incision is closed with sutures.

4. Qualifying circumstances

CPT 33963 is performed on children from birth through 5 years of age who require repositioning of central cannula(e) for extracorporeal circulation. This procedure is typically necessary for patients undergoing ECMO or ECLS. The use of fluoroscopic guidance may be required during the repositioning process.

5. When to use CPT code 33963

CPT code 33963 should be used when a physician performs the repositioning of central cannula(e) through sternotomy or thoracotomy in children from birth through 5 years of age. This code should not be used for patients older than 5 years.

6. Documentation requirements

To support a claim for CPT 33963, the physician must document the following information:

• Patient’s age
• Reason for the repositioning of central cannula(e)
• Details of the procedure, including the approach used (sternotomy or thoracotomy)
• Use of fluoroscopic guidance, if applicable
• Any complications or additional procedures performed
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 33963, ensure that the procedure is performed by a physician and that the patient falls within the specified age range (birth through 5 years). Fluoroscopic guidance, if used, should be documented and reported separately. It is important to review payer-specific guidelines and policies to ensure accurate billing and reimbursement.

8. Historical information

CPT 33963 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 repositions the central cannula(e) through sternotomy in a 3-year-old child undergoing ECMO.
2. A surgeon performs the repositioning of central cannula(e) by thoracotomy in a newborn requiring ECLS.
3. A pediatric cardiothoracic surgeon repositions the central cannula(e) through sternotomy in a 2-year-old patient on ECMO.
4. A physician repositions the central cannula(e) by thoracotomy in a 4-year-old child undergoing ECLS.
5. A cardiothoracic surgeon performs the repositioning of central cannula(e) through sternotomy in a 5-year-old patient on ECMO.
6. A pediatric surgeon repositions the central cannula(e) by thoracotomy in a 1-year-old child requiring ECLS.
7. A physician repositions the central cannula(e) through sternotomy in a 3-month-old infant undergoing ECMO.
8. A surgeon performs the repositioning of central cannula(e) by thoracotomy in a 2-week-old newborn on ECLS.
9. A pediatric cardiothoracic surgeon repositions the central cannula(e) through sternotomy in a 4-year-old patient on ECMO.
10. A physician repositions the central cannula(e) by thoracotomy in a 5-year-old child undergoing ECLS.