How To Use CPT Code 33988

CPT 33988 describes the insertion of a venting catheter in the left heart through a thoracic incision, such as a sternotomy or thoracotomy, as part of 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 33988?

CPT 33988 can be used to describe the insertion of a venting catheter in the left heart through a thoracic incision, such as a sternotomy or thoracotomy. This procedure is typically performed as part of extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) to assist the heart and lungs in their function and allow them to recover. The venting catheter helps prevent heart chamber distension and is inserted by a healthcare provider during a surgical procedure.

2. Official Description

The official description of CPT code 33988 is: ‘Insertion of left heart vent by thoracic incision (eg, sternotomy, thoracotomy) for ECMO/ECLS.’

3. Procedure

1. The patient is appropriately prepped and anesthetized for the procedure.
2. The healthcare provider accesses the patient’s heart through a thoracic incision, such as a sternotomy or thoracotomy.
3. An incision is made at the junction of the right superior pulmonary vein and left atrium, advancing to the apex of the left ventricle.
4. The healthcare provider ensures hemostasis and inserts the venting catheter through the incision into the left ventricle.
5. The venting catheter is connected to the rest of the ECMO or ECLS circuit, such as the venous ECMO circuit.
6. The site is flushed with sterile saline and the incision is closed with sutures in layers.

4. Qualifying circumstances

CPT 33988 is performed as part of ECMO or ECLS procedures, which are used to support the heart and lungs in patients who are critically ill or experiencing organ failure. The insertion of the venting catheter is necessary to prevent heart chamber distension and maintain proper functioning of the heart during ECMO or ECLS. This procedure is typically performed by a healthcare provider with expertise in cardiac surgery or thoracic surgery.

5. When to use CPT code 33988

CPT code 33988 should be used when a healthcare provider performs the insertion of a venting catheter in the left heart through a thoracic incision as part of an ECMO or ECLS procedure. This code accurately describes the specific procedure and distinguishes it from other cardiac or thoracic procedures. It is important to ensure that the documentation supports the use of CPT code 33988 and that the procedure meets the necessary qualifying circumstances.

6. Documentation requirements

To support a claim for CPT code 33988, the healthcare provider must document the following information:

• Indication for the ECMO or ECLS procedure
• Details of the thoracic incision, such as sternotomy or thoracotomy
• Specific location of the incision and advancement of the venting catheter
• Connection of the venting catheter to the ECMO or ECLS circuit
• Confirmation of hemostasis and closure of the incision
• Any additional relevant details or complications encountered during the procedure

7. Billing guidelines

When billing for CPT code 33988, it is important to ensure that the procedure meets the necessary qualifying circumstances and is accurately documented. The use of this code should be supported by the medical necessity of the ECMO or ECLS procedure and the insertion of the venting catheter. It is also important to follow any specific billing guidelines provided by the payer or coding guidelines. It is recommended to review the complete documentation and consult with the appropriate coding resources to ensure accurate and compliant billing.

8. Historical information

CPT code 33988 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, indicating that it is typically performed in an inpatient setting.

9. Examples

1. A cardiac surgeon performing the insertion of a venting catheter in the left heart through a sternotomy as part of an ECMO procedure for a patient with severe heart failure.
2. A thoracic surgeon inserting a venting catheter in the left heart through a thoracotomy during an ECLS procedure for a patient with acute respiratory distress syndrome.
3. A cardiothoracic surgeon performing the insertion of a venting catheter in the left heart through a sternotomy as part of an ECMO procedure for a patient undergoing cardiac surgery.
4. A cardiac surgeon inserting a venting catheter in the left heart through a thoracotomy during an ECLS procedure for a patient with cardiogenic shock.
5. A thoracic surgeon performing the insertion of a venting catheter in the left heart through a sternotomy as part of an ECMO procedure for a patient with severe pulmonary hypertension.
6. A cardiothoracic surgeon inserting a venting catheter in the left heart through a thoracotomy during an ECLS procedure for a patient with acute myocardial infarction.
7. A cardiac surgeon performing the insertion of a venting catheter in the left heart through a sternotomy as part of an ECMO procedure for a patient with postoperative cardiac arrest.