CPT® Code 33955

Official Description

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of central cannula(e) by sternotomy or thoracotomy, 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 circulation of blood outside the body through an artificial lung, which oxygenates the blood before it is returned to the patient's bloodstream. The insertion of central cannula(e) is a vital step in this process, allowing for the effective management of blood flow during the procedure. The cannulae are inserted using a transthoracic approach, which can be performed via sternotomy or thoracotomy. This surgical technique is often employed during cardiac surgeries when a patient is unable to transition from cardiopulmonary bypass to normal heart function. The surgeon accesses the chest cavity by making an incision either between the ribs or along the sternum, providing the necessary access to the heart and major blood vessels. Depending on the patient's condition, specific areas such as the right atrial appendage, aortic arch, or ascending aorta may be cannulated. In cases of primary left heart failure, the left atrium may be cannulated to relieve pressure. Once the cannulae are in place, they are connected to the ECMO/ECLS circuit, and the chest is subsequently closed, ensuring that the tubing is secured for optimal function. The use of CPT® code 33955 is specifically designated for this procedure when performed on patients ranging from newborns to 5 years of age, while code 33956 applies to patients aged 6 years and older.

1. Indications

The procedure of inserting central cannula(e) for extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) is indicated for patients who exhibit severe heart and lung failure. This may include conditions such as:

Severe respiratory failure requiring prolonged mechanical ventilation and support.
Cardiac failure that necessitates temporary support to allow the heart to recover.
Congenital heart defects in pediatric patients that impair normal heart function.
Post-cardiotomy failure where patients are unable to wean off cardiopulmonary bypass after cardiac surgery.

2. Procedure

The procedure for the insertion of central cannula(e) by sternotomy or thoracotomy involves several critical steps:

Step 1: Patient Preparation The patient is positioned appropriately, and standard monitoring is established. Anesthesia is administered to ensure the patient is unconscious and pain-free during the procedure.
Step 2: Surgical Access The surgeon makes an incision either along the sternum (sternotomy) or between the ribs (thoracotomy) to gain access to the thoracic cavity. This allows for direct visualization and access to the heart and major blood vessels.
Step 3: Cannulation Depending on the clinical scenario, the surgeon cannulates the right atrial appendage and the aortic arch or ascending aorta. In cases of left heart failure, the left atrium may be cannulated to facilitate decompression of the left heart.
Step 4: Connection to ECMO/ECLS Circuit The cannulae are then connected to the ECMO/ECLS circuit, which includes an artificial lung that oxygenates the blood. This connection is crucial for the support of the patient's circulatory and respiratory functions.
Step 5: Closure and Securing Tubing After ensuring proper placement and function of the cannulae, the chest is closed, and the tubing is secured to prevent any dislodgement or complications during the ECMO/ECLS support period.

3. Post-Procedure

Post-procedure care involves close monitoring of the patient for any complications related to the cannulation and ECMO/ECLS support. This includes assessing hemodynamic stability, monitoring for signs of bleeding or infection at the cannulation sites, and ensuring that the ECMO/ECLS circuit is functioning properly. The patient will typically remain in an intensive care setting for ongoing support and observation. Recovery may vary based on the underlying condition and the patient's response to the ECMO/ECLS therapy.

Short Descr	ECMO/ECLS INSJ CTR CANNULA
Medium Descr	ECMO/ECLS INSJ OF CENTRAL CANNULA BIRTH-5 YRS
Long Descr	Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of central cannula(e) by sternotomy or thoracotomy, 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)	1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66)	1 - Team surgeons could be paid, though...
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)