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Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) are terms that refer to advanced medical procedures designed to provide temporary support for patients with severe heart and lung dysfunction. These procedures are typically utilized for a duration ranging from three to ten days, during which they facilitate the oxygenation of blood outside the body. The process involves draining venous blood from a large central vein, which is then passed through an artificial lung for oxygenation before being returned to the bloodstream, either to the venous system or a major artery. The insertion of peripheral arterial and/or venous cannulae is performed using an open surgical technique, which entails making an incision in the skin over the targeted vessel, such as the femoral or jugular vein. This incision allows for the dissection of underlying tissues to access the vessel. A small opening is created in the vessel itself, through which a guidewire is introduced and positioned accurately, often confirmed via fluoroscopy. The vessel is then dilated progressively to accommodate the cannula or introducer unit, which is advanced over the guidewire. Once the correct placement is verified, the guidewire and introducer are removed, and the cannula is secured. The ECMO/ECLS circuit, which has been prepped and primed, is then connected to the cannula, initiating the life-support treatment. Following the procedure, the incisions are closed, and the tubing is secured to ensure stability. It is important to note that CPT® Code 33953 is designated for the insertion of open peripheral cannulae in patients from newborn to 5 years old, while CPT® Code 33954 applies to patients aged 6 years and older.
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The procedure described by CPT® Code 33954 is indicated for patients who require advanced respiratory and circulatory support due to severe heart and lung failure. This may include conditions such as:
The procedure for the insertion of peripheral arterial and/or venous cannulae using CPT® Code 33954 involves several critical steps:
Post-procedure care following the insertion of peripheral cannulae for ECMO/ECLS involves close monitoring of the patient’s vital signs and hemodynamic status. Healthcare providers will assess the function of the ECMO/ECLS circuit to ensure it is operating effectively. Regular checks for signs of infection at the cannulation site, as well as monitoring for potential complications such as bleeding or thrombosis, are essential. The patient may require additional supportive care, including sedation and analgesia, to ensure comfort during the duration of the ECMO/ECLS support. The expected recovery period will depend on the underlying condition being treated and the patient's overall response to the procedure.
| Short Descr | ECMO/ECLS INSJ PRPH CANNULA | Medium Descr | ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN | Long Descr | Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), open, 6 years and older | 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) |
| 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. | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 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. | 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.) | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | 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) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2015-01-01 | Added | Added |
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