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Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) are terms that refer to advanced medical procedures designed to provide long-term support for patients experiencing severe heart and lung failure. These procedures typically last from three to ten days and involve the circulation of blood outside the body through an artificial lung, which oxygenates the blood before returning it to the patient's bloodstream. In the case of veno-venous (V-V) ECMO/ECLS, blood is drawn from a large central vein, oxygenated, and then returned to the venous system. Conversely, veno-arterial (V-A) ECMO/ECLS involves drawing venous blood from a large central vein and returning it to a major artery after it has been oxygenated. The initiation of ECMO/ECLS is a complex process that requires a thorough evaluation of the patient's condition, including various diagnostic tests such as laboratory analyses, X-rays, cardiograms or echocardiograms, and neurological assessments, particularly in neonates. Informed consent from the patient or their family is a critical step in this process. The setup of the ECMO equipment, which includes the ECMO pump, anticoagulation testing (ACT) machine, tubing, and ECMO bed, is essential before the procedure can commence. Medications and blood products are also prepared in advance. Once the ECMO circuit is ready, and the medical team is in position, the cannulation of the vessels can occur, allowing for the initiation of ECMO/ECLS therapy. This procedure can be performed by qualified healthcare professionals such as neonatologists, pediatric intensivists, surgeons, or interventional cardiologists, with continuous monitoring provided by a perfusion specialist to ensure patient safety and efficacy of the treatment.
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The initiation of veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) is indicated for patients experiencing severe cardiac and respiratory failure. The following conditions may warrant the use of this advanced life support system:
The procedure for initiating veno-arterial (V-A) ECMO/ECLS involves several critical steps to ensure the safety and effectiveness of the treatment. The following outlines the procedural steps:
Following the initiation of veno-arterial (V-A) ECMO/ECLS, continuous monitoring of the patient is essential. A perfusion specialist is responsible for overseeing the ECMO circuit and ensuring that the patient remains stable throughout the therapy. Post-procedure care includes regular assessments of the patient's hemodynamic status, oxygenation levels, and overall response to the treatment. Adjustments to the ECMO settings may be necessary based on the patient's condition. Additionally, the medical team must be vigilant for potential complications associated with ECMO/ECLS, such as bleeding, infection, or thrombosis, and address these issues promptly to ensure optimal patient outcomes.
| Short Descr | ECMO/ECLS INITIATION ARTERY | Medium Descr | ECMO/ECLS INITIATION VENO-ARTERIAL | Long Descr | Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; initiation, veno-arterial | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 1 |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | ET | Emergency services | FS | Split (or shared) evaluation and management visit | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | RT | Right side (used to identify procedures performed on the right side of the body) | X3 | Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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