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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 with severe heart and lung dysfunction. These procedures involve the use of an artificial lung to oxygenate blood outside the body, allowing it to be circulated back into the bloodstream. The process is critical for patients who are unable to maintain adequate oxygenation or perfusion due to various medical conditions. The peripheral arterial and/or venous cannula(e) utilized in ECMO/ECLS are typically inserted into the vena cava, where desaturated blood is drawn from the inferior vena cava (IVC) into the ECMO/ECLS circuit. Once oxygenated, the blood is returned to the superior vena cava, entering the right atrium and subsequently directed towards the tricuspid valve. Maintaining optimal positioning of the cannula(e) is essential for effective ECMO/ECLS support, as any migration can lead to recirculation and suboptimal oxygenation. The procedure for repositioning these cannula(e) is performed percutaneously, which involves the removal of any dressings or sutures that secure the tubing to the skin. Under fluoroscopic guidance, the physician carefully manipulates the cannula(e) to ensure they are optimally placed, confirming the correct positioning before reconnecting the ECMO/ECLS circuit. This procedure is specifically indicated for patients aged 6 years and older, as denoted by CPT® Code 33958, while a different code, 33957, is applicable for younger patients, specifically newborns through 5 years of age.
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Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) are indicated for patients experiencing severe cardiac and respiratory failure. The following conditions may warrant the use of ECMO/ECLS:
The procedure for repositioning peripheral arterial and/or venous cannula(e) in patients aged 6 years and older involves several critical steps to ensure optimal placement and functionality of the ECMO/ECLS system:
Post-procedure care following the repositioning of peripheral cannula(e) involves monitoring the patient for any signs of complications, such as bleeding, infection, or improper cannula placement. Continuous assessment of the patient's hemodynamic status and oxygenation levels is essential to ensure the effectiveness of the ECMO/ECLS support. The healthcare team should also provide appropriate wound care for the insertion sites and ensure that the cannula(e) remain secure. Regular imaging may be performed to confirm the ongoing proper positioning of the cannula(e) and to assess the function of the ECMO/ECLS circuit.
| Short Descr | ECMO/ECLS REPOS PERPH CNULA | Medium Descr | ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER | Long Descr | Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older (includes fluoroscopic guidance, when performed) | 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 |
| 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. | 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. | 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.) | 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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