How To Use CPT Code 33964

CPT 33964 describes the repositioning of central cannula(e) for extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) provided by a physician through a sternotomy or thoracotomy approach 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 33964?

CPT 33964 can be used to describe the repositioning of central cannula(e) for ECMO or ECLS provided by a physician through a sternotomy or thoracotomy approach in patients aged six years and older. This code is used when the physician repositions the cannula(e) to ensure proper extracorporeal circulation and oxygenation of the blood.

2. Official Description

The official description of CPT code 33964 is: ‘Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition central cannula(e) by sternotomy or thoracotomy, 6 years and older (includes fluoroscopic guidance, when performed).’ Notes: (Do not report 33963, 33964 in conjunction with 32100, 39010) (Do not report 33957, 33958, 33959, 33962, 33963, 33964 in conjunction with 33946, 33947).

3. Procedure

1. The physician prepares the patient for the procedure, ensuring appropriate anesthesia and positioning.
2. An incision is made over the breastbone or chest, exposing the central cannula(e) that require repositioning.
3. The physician cleans the area around the right jugular vein and repositions the central cannula(e) into the right atrium of the heart through the right jugular vein.
4. Fluoroscopic guidance may be used to assist the physician in visualizing the cannula(e) and ensuring proper placement.
5. The extracorporeal circulation device is used to actively pump the blood through the oxygenator, where gas exchange occurs, before returning the oxygenated blood to the patient through the cannula(e).
6. The incision is closed with sutures.

4. Qualifying circumstances

CPT 33964 is performed on patients aged six years and older who require repositioning of central cannula(e) for ECMO or ECLS. This procedure is typically performed when the patient’s condition necessitates extracorporeal circulation and oxygenation of the blood. The physician must use a sternotomy or thoracotomy approach to access and reposition the central cannula(e). Fluoroscopic guidance may be used during the procedure to ensure accurate placement.

5. When to use CPT code 33964

CPT code 33964 should be used when a physician repositions central cannula(e) for ECMO or ECLS in patients aged six years and older. This code should not be reported in conjunction with codes 32100 or 39010. Additionally, it should not be reported with codes 33946 or 33947.

6. Documentation requirements

To support a claim for CPT 33964, the physician must document the following information:

• Patient’s age and diagnosis necessitating ECMO or ECLS
• Details of the procedure, including the approach used (sternotomy or thoracotomy)
• Use of fluoroscopic guidance, if applicable
• Date and duration of the procedure
• Any complications or additional procedures performed
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 33964, ensure that the procedure is performed by a physician and that the repositioning of central cannula(e) is done through a sternotomy or thoracotomy approach. Do not report CPT 33964 in conjunction with codes 32100 or 39010. Additionally, do not report it with codes 33946 or 33947.

8. Historical information

CPT 33964 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 the central cannula(e) for ECMO in a 10-year-old patient through a sternotomy approach.
2. Using a thoracotomy approach, a physician repositions the central cannula(e) for ECLS in a 40-year-old patient.
3. During a repositioning procedure, a physician utilizes fluoroscopic guidance to ensure accurate placement of the central cannula(e) for ECMO in a 70-year-old patient.
4. A 25-year-old patient requires repositioning of central cannula(e) for ECLS, and the physician performs the procedure through a sternotomy approach.
5. Using a thoracotomy approach, a physician repositions the central cannula(e) for ECMO in a 60-year-old patient.
6. A 50-year-old patient undergoes a repositioning procedure for central cannula(e) for ECLS, performed by a physician through a sternotomy approach.