CPT® Code 33953

Official Description

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age

Common Language Description

Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) are terms that refer to a critical medical procedure used to provide long-term support for patients experiencing severe heart and lung failure. This procedure typically lasts from three to ten days and involves the use of a sophisticated system that takes over the function of the heart and lungs by circulating blood outside the body through an artificial lung, where it is oxygenated before being returned to the bloodstream. The process begins with the drainage of venous blood from a large central vein, which is then oxygenated and returned either to the venous system or a major artery, depending on the specific clinical scenario. The insertion of peripheral arterial and/or venous cannulae is performed using an open surgical technique, which involves making an incision in the skin over the targeted vessel, such as the femoral or jugular vein. This incision allows the physician to dissect the underlying tissue to access the vessel directly. A small opening is created in the vessel, and a guidewire is introduced to facilitate the placement of the cannula. The correct positioning of the guidewire is confirmed through fluoroscopy, a real-time imaging technique that allows for precise placement. The vessel is then serially dilated to accommodate the cannula or introducer unit, which is advanced over the guidewire. Once the cannula is correctly positioned, the guidewire and introducer are removed, and the cannula is clamped to secure it in place. The ECMO/ECLS circuit, which has been pre-primed with a sterile solution, is then connected to the cannula, initiating the life-support treatment. Finally, the incisions made during the procedure are closed, and the tubing is secured to ensure stability and prevent dislodgment. This code, CPT® 33953, specifically applies to the insertion of peripheral cannulae in patients ranging from newborns to 5 years of age, while a different code, CPT® 33954, is designated for patients aged 6 years and older.

1. Indications

The procedure described by CPT® code 33953 is indicated for patients who require advanced life support due to severe cardiac and respiratory failure. The following conditions may warrant the use of ECMO/ECLS:

Severe Respiratory Distress: Conditions such as acute respiratory distress syndrome (ARDS) or severe pneumonia that compromise the ability of the lungs to oxygenate blood effectively.
Cardiac Failure: Situations where the heart is unable to pump sufficient blood to meet the body's needs, such as cardiogenic shock or severe congenital heart defects.
Post-Cardiac Surgery Support: Patients who require additional support following complex cardiac surgeries where heart and lung function may be temporarily impaired.
Sepsis or Shock: Critical illness scenarios where systemic infection or shock leads to multi-organ failure, necessitating temporary support for heart and lung function.

2. Procedure

The procedure for the insertion of peripheral cannulae for ECMO/ECLS involves several critical steps to ensure proper placement and functionality:

Step 1: Patient Preparation The patient is positioned appropriately, and the area where the cannula will be inserted is cleaned and sterilized to minimize the risk of infection. Anesthesia may be administered to ensure the patient's comfort during the procedure.
Step 2: Incision and Vessel Access An incision is made in the skin over the selected vessel, typically the femoral or jugular vein. The underlying tissue is carefully dissected to expose the vessel, allowing for direct access.
Step 3: Guidewire Introduction A small incision is made in the vessel, and a guidewire is introduced. The guidewire is advanced to the appropriate position, which is confirmed using fluoroscopy to ensure accurate placement within the vessel.
Step 4: Cannula Insertion The vessel is serially dilated to accommodate the cannula or introducer unit. Once the vessel is adequately dilated, the cannula is advanced over the guidewire into the correct position.
Step 5: Confirmation and Connection After confirming the correct position of the cannula, the guidewire and introducer are removed. The cannula is then clamped to secure it in place, and the pre-primed ECMO/ECLS circuit is connected to the cannula, initiating the life-support treatment.
Step 6: Closure and Securing Tubing The incisions made during the procedure are closed, and the tubing is secured to prevent dislodgment and ensure stability during the ECMO/ECLS treatment.

3. Post-Procedure

After the insertion of the peripheral cannulae, the patient will be closely monitored for any complications or signs of distress. Continuous assessment of vital signs, oxygenation levels, and overall hemodynamic status is essential to ensure the effectiveness of the ECMO/ECLS support. The healthcare team will also monitor the insertion sites for any signs of infection or bleeding. Depending on the patient's condition, additional interventions may be required to optimize support and facilitate recovery. The duration of ECMO/ECLS support typically ranges from three to ten days, during which the patient's response to treatment will be evaluated regularly. Once the underlying condition improves, the healthcare team will plan for the gradual weaning off of ECMO/ECLS support, followed by the safe removal of the cannulae.

Short Descr	ECMO/ECLS INSJ PRPH CANNULA
Medium Descr	ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN
Long Descr	Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age
Status Code	Active Code
Global Days	000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	2 - Standard 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)	0 - 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

This is a primary code that can be used with these additional add-on codes.

33987

Addon Code Resequenced Code MPFS Status: Active Code APC C 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)

51	Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
78	Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
80	Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
GC	This service has been performed in part by a resident under the direction of a teaching physician