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Official Description

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; removal of central cannula(e) by sternotomy or thoracotomy, 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 a medical procedure providing long-term heart and lung bypass support. This procedure involves circulating blood outside the body through an artificial lung, which oxygenates the blood before returning it to the bloodstream. The specific procedure described by CPT® Code 33985 pertains to the removal of central cannula(e) in patients aged birth through 5 years. The removal is performed via a transthoracic approach, which includes surgical techniques such as sternotomy or thoracotomy. These approaches involve making an incision in the chest to access the heart and lungs directly. The procedure is critical in managing patients who require prolonged support for cardiac and respiratory function, ensuring that the cannula(e) are removed safely to minimize complications such as air embolism. The careful technique employed during the removal process is essential for the patient's recovery and overall outcome.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) are indicated for patients who require advanced support for cardiac and respiratory failure. The specific indications for the procedure associated with CPT® Code 33985 include:

  • Severe respiratory failure requiring prolonged mechanical ventilation.
  • Cardiac failure that is unresponsive to conventional therapies.
  • Congenital heart defects in neonates and young children that necessitate temporary support during surgical interventions.
  • Post-operative support for patients who have undergone cardiac surgery and require additional assistance for recovery.

2. Procedure

The procedure for the removal of central cannula(e) via sternotomy or thoracotomy involves several critical steps to ensure patient safety and procedural success. The steps are as follows:

  • Step 1: Patient Positioning The patient is positioned in a slight Trendelenburg or supine position to facilitate access to the chest cavity. This positioning helps in managing the hemodynamics during the procedure.
  • Step 2: Circuit Preparation The ECMO/ECLS circuit tubing is clamped to prevent blood flow during the cannula removal process. This step is crucial to minimize blood loss and maintain hemodynamic stability.
  • Step 3: Incision Opening The previous chest incision is carefully opened to access the central cannula(e) and associated vessels. This may involve dissecting through layers of tissue to reach the cannula(e).
  • Step 4: Identification and Cutting of Sutures The cannula(e) and the vessel(s) are identified, and any stay sutures that secure the cannula(e) in place are cut. This step is essential for the safe removal of the cannula(e).
  • Step 5: Cannula Removal The cannula(e) is withdrawn from the vessel using rapid, steady pressure. If the patient is intubated and on ventilator support, the cannula(e) should be removed during the inspiratory phase to reduce the risk of air embolism.
  • Step 6: Vessel Closure After the cannula(e) has been successfully removed, the vessel is closed using vascular suture to ensure hemostasis and proper healing.
  • Step 7: Closure of Fascia and Skin The fascia is closed with absorbable suture, and the skin is closed using sutures or staples, depending on the surgeon's preference and the specific case requirements.
  • Step 8: Dressing Application A sterile dressing is applied over the incision site to protect it from infection and promote healing.

3. Post-Procedure

Post-procedure care following the removal of central cannula(e) involves monitoring the patient for any signs of complications, such as bleeding or infection at the incision site. The patient may require continued respiratory support and close observation in a critical care setting. Recovery expectations will vary based on the patient's underlying condition and overall health status. It is essential to follow up with appropriate imaging or assessments to ensure that the vascular closure is intact and that there are no complications arising from the procedure.

Short Descr ECMO/ECLS RMVL CTR CANNULA
Medium Descr ECMO/ECLS REMOVAL OF CENTRAL CANNULA BIRTH-5 YRS
Long Descr Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; removal 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
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.)
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
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2015-01-01 Added Added
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