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Official Description

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

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) are terms that refer to advanced medical procedures used to provide prolonged heart and lung support for patients whose heart and lungs are severely compromised. These procedures involve the use of a machine that takes over the function of these vital organs by circulating blood outside the body through an artificial lung, where it is oxygenated before being returned to the bloodstream. The process is critical for patients who are unable to maintain adequate oxygenation and perfusion due to various medical conditions. The procedure described by CPT® Code 33965 specifically pertains to the removal of peripheral cannulae, which are tubes inserted into the blood vessels to facilitate this life-sustaining support. This particular code applies to patients from birth through 5 years of age, highlighting the specialized care required for this younger population. The removal of these cannulae must be performed with precision and care to minimize complications, such as bleeding or air embolism, and is typically conducted by a physician in a controlled environment.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) are indicated for patients experiencing severe respiratory or cardiac failure. The following conditions may warrant the use of ECMO/ECLS:

  • Severe Respiratory Distress Patients with conditions such as acute respiratory distress syndrome (ARDS), pneumonia, or other severe lung diseases that impair gas exchange.
  • Cardiac Failure Individuals suffering from cardiogenic shock, severe heart failure, or post-cardiotomy support where the heart is unable to pump effectively.
  • Congenital Heart Defects Newborns and young children with congenital heart defects that require temporary support while awaiting surgical intervention.
  • Sepsis Patients with septic shock who require support for both cardiac and respiratory function due to systemic infection.

2. Procedure

The procedure for the removal of peripheral cannulae in patients receiving ECMO/ECLS support involves several critical steps to ensure safety and effectiveness:

  • Step 1: Patient Positioning The patient is positioned in either a slight Trendelenburg or supine position to facilitate the removal of the cannulae. This positioning helps to reduce the risk of air embolism during the procedure.
  • Step 2: Circuit Preparation The ECMO/ECLS circuit tubing is clamped to prevent blood flow during the removal process. This step is crucial to minimize blood loss and maintain hemodynamic stability.
  • Step 3: Dressing and Suture Removal The dressing and/or sutures that secure the cannulae to the skin are carefully removed. This step must be performed with caution to avoid disrupting the surrounding tissue.
  • Step 4: Cannula Withdrawal The cannulae are withdrawn from the vessel using rapid, steady pressure in a parallel line to the skin. This technique is essential to ensure a smooth removal and to minimize trauma to the vessel.
  • Step 5: Ventilator Coordination To reduce the risk of air embolism, the removal should ideally occur during the inspiratory phase of the ventilator cycle for intubated patients. If the patient is conscious and able to follow directions, the cannula should be withdrawn during exhalation or Valsalva maneuver.
  • Step 6: Hemostasis and Dressing After the cannulae are removed, pressure is applied to the site to control any bleeding. A sterile dressing is then placed over the wound to protect it and promote healing.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any signs of complications, such as bleeding or infection at the cannula site. Continuous assessment of vital signs and hemodynamic stability is essential. The healthcare team should also observe for any signs of air embolism, particularly in patients who were intubated during the procedure. The dressing should be kept clean and dry, and any changes in the wound site should be documented and reported. Follow-up care may include further imaging or interventions if complications arise.

Short Descr ECMO/ECLS RMVL PERPH CANNULA
Medium Descr ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS
Long Descr Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; removal of peripheral (arterial and/or venous) cannula(e), percutaneous, 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
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.
GC This service has been performed in part by a resident under the direction of a teaching physician
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2015-01-01 Added Added
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