How To Use CPT Code 33987

CPT 33987 describes the creation of a graft conduit to facilitate arterial perfusion for extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS). 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 33987?

CPT 33987 can be used to describe the creation of a graft conduit to facilitate arterial perfusion for ECMO or ECLS. This code is used when a provider creates a graft channel to help achieve arterial perfusion for these specialized procedures. The graft conduit is an important component in allowing the ECMO or ECLS machine to take on the work of the heart and lungs, allowing those organs to recover.

2. Official Description

The official description of CPT code 33987 is: ‘Arterial exposure with creation of graft conduit (eg, chimney graft) to facilitate arterial perfusion for ECMO/ECLS (List separately in addition to code for primary procedure).’ This code should be used in conjunction with the primary procedure code for ECMO or ECLS, such as codes 33953, 33954, 33955, or 33956. It should not be reported with codes 34714, 34716, or 34833.

3. Procedure

1. During the same session as the insertion of peripheral or central cannulae for ECMO or ECLS, the provider creates a graft channel to facilitate arterial perfusion.
2. The provider accesses the target artery, such as the femoral artery in the groin.
3. The artery is clamped and incised longitudinally.
4. A graft is anastomosed to the arterial opening in an end-to-side fashion.
5. The graft is clamped, and the artery is unclamped to allow for coagulation of the stitch holes.
6. A tunnel is created in the graft under the skin to introduce an arterial cannula into the graft, allowing for arterial perfusion.
7. The provider completes the primary procedure, ensures hemostasis, and closes the site as needed with sutures in layers.

4. Qualifying circumstances

CPT 33987 is used when a graft conduit is created to facilitate arterial perfusion for ECMO or ECLS. This procedure is typically performed during the same session as the insertion of peripheral or central cannulae for ECMO or ECLS. The target artery, such as the femoral artery, is accessed, and a graft is anastomosed to facilitate arterial perfusion. This procedure is performed to support patients who require ECMO or ECLS to take over the function of their heart and lungs.

5. When to use CPT code 33987

CPT code 33987 should be used when a provider creates a graft conduit to facilitate arterial perfusion for ECMO or ECLS. It is important to note that this code should only be reported in conjunction with the primary procedure code for ECMO or ECLS, such as codes 33953, 33954, 33955, or 33956. It should not be reported with codes 34714, 34716, or 34833.

6. Documentation requirements

To support a claim for CPT 33987, the provider must document the following information:

• Indication for ECMO or ECLS and the need for arterial perfusion
• Specific details of the graft conduit creation, including the target artery accessed and the type of graft used
• Date and time of the procedure
• Details of the primary procedure for ECMO or ECLS
• Confirmation of hemostasis and closure of the site
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 33987, ensure that the procedure is performed during the same session as the insertion of peripheral or central cannulae for ECMO or ECLS. Report this code in addition to the primary procedure code for ECMO or ECLS, such as codes 33953, 33954, 33955, or 33956. Do not report CPT 33987 with codes 34714, 34716, or 34833. It is important to note that CPT 33987 is an add-on code and should not be reported without an appropriate primary code.

8. Historical information

CPT 33987 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 to the code since its addition.

9. Examples

1. A provider creates a graft conduit to facilitate arterial perfusion for ECMO in a patient with severe respiratory failure.
2. During an ECLS procedure, a graft conduit is created to ensure arterial perfusion in a patient with cardiac arrest.
3. A provider performs the creation of a graft conduit to support arterial perfusion during ECMO in a patient undergoing cardiac surgery.
4. During an ECLS procedure for a patient with septic shock, a graft conduit is created to maintain arterial perfusion.
5. A provider performs the creation of a graft conduit to facilitate arterial perfusion for ECMO in a patient with acute respiratory distress syndrome.
6. During an ECLS procedure for a patient with cardiogenic shock, a graft conduit is created to ensure arterial perfusion.
7. A provider creates a graft conduit to support arterial perfusion during ECMO in a patient with pulmonary embolism.
8. During an ECLS procedure for a patient with acute myocardial infarction, a graft conduit is created to maintain arterial perfusion.
9. A provider performs the creation of a graft conduit to facilitate arterial perfusion for ECMO in a patient with severe pneumonia.
10. During an ECLS procedure for a patient with acute respiratory failure, a graft conduit is created to ensure arterial perfusion.