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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 a sophisticated system that circulates blood outside the body through an artificial lung, where it is oxygenated before being returned to the bloodstream. This process is critical for patients whose heart and lungs are unable to function adequately on their own, allowing for temporary support while the underlying condition is treated or while the organs recover. The peripheral arterial and/or venous cannula(e) used in ECMO/ECLS are typically inserted into the vena cava, facilitating the flow of desaturated blood from the inferior vena cava (IVC) to the ECMO/ECLS circuit. The oxygenated blood is then returned to the superior vena cava, directing flow towards the right atrium and subsequently the tricuspid valve. Proper positioning of the cannula(e) is essential for optimal support, as any migration can lead to inadequate circulation and potential complications. The procedure for repositioning these cannula(e) involves an open technique, which includes the removal of dressings and sutures, accessing the vessel through an incision, and utilizing fluoroscopic guidance to ensure accurate placement. This meticulous process is crucial for maintaining effective ECMO/ECLS support in patients aged 6 years and older.
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The procedure described by CPT® Code 33962 is indicated for patients who require repositioning of peripheral arterial and/or venous cannula(e) as part of their extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) treatment. This may be necessary due to complications arising from cannula migration, which can lead to suboptimal support and inadequate oxygenation of the blood. The procedure is specifically applicable to patients aged 6 years and older who are undergoing ECMO/ECLS therapy.
The procedure for repositioning peripheral cannula(e) under CPT® Code 33962 involves several critical steps to ensure proper placement and functionality. First, the physician removes the dressing and/or sutures that secure the cannula tubing to the skin, allowing access to the insertion site. If the cannula was previously inserted using an open technique, the physician may choose to open the existing incision or create a new one by incising the skin. Once access to the vessel is achieved, the sutures that secure the cannula to the vessel are cut, allowing for manipulation of the cannula. Under fluoroscopic guidance, the physician gently pulls back the cannula(e) or may use a snare to grasp the cannula through the incision. This manipulation continues until optimal placement is confirmed, ensuring that the cannula is positioned correctly for effective blood flow. After confirming the proper placement, the physician secures the cannula in the vessel with sutures and closes the incision. Finally, the ECMO/ECLS circuit is reconnected, and the tubing is secured to the skin using additional sutures and/or dressings to maintain stability and prevent dislodgement.
After the repositioning of the peripheral cannula(e) is completed, the patient will require careful monitoring to ensure that the ECMO/ECLS support is functioning optimally. This includes observing for any signs of complications such as bleeding, infection, or improper cannula placement. The healthcare team will also assess the patient's hemodynamic status and oxygenation levels to confirm that the procedure has successfully restored effective support. Additionally, the site of the incision will need to be monitored for proper healing and to ensure that the sutures and dressings remain intact. Follow-up imaging may be necessary to verify the position of the cannula(e) and the overall effectiveness of the ECMO/ECLS therapy.
| Short Descr | ECMO/ECLS REPOS PERPH CNULA | Medium Descr | ECMO/ECLS REPOS PERPH CANNULA OPEN 6 YRS & OLDER | Long Descr | Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), open, 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure 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 | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area |
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