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The procedure described by CPT® Code 33987 involves the creation of a graft conduit, such as a chimney graft, to enhance arterial perfusion in patients undergoing Extracorporeal Membrane Oxygenation (ECMO) or Extracorporeal Life Support (ECLS). This intervention is particularly crucial when the arterial vessels are small or when there is a risk of limb ischemia due to cannulation. The graft conduit serves to facilitate both antegrade and retrograde blood flow by deploying a covered stent parallel to the ECMO/ECLS cannulae, typically within the femoral or axillary vessels. The design of the stent allows it to extend proximally, thereby preserving blood flow to the side branches of the main arterial vessel, which is essential for maintaining adequate perfusion to the surrounding tissues. The graft conduit can be implemented either as a planned procedure during the initial placement of the ECMO/ECLS cannulae or as a rescue intervention to salvage side branches that may be compromised later in the course of therapy. The insertion of the graft conduit generally necessitates an open technique, often referred to as a cut down, to gain access to the vessel. Confirmation of the proper placement of the graft conduit or stent is typically achieved through imaging techniques such as fluoroscopy or transesophageal echocardiography (TEE), ensuring that the procedure is performed accurately and effectively.
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The procedure associated with CPT® Code 33987 is indicated for specific clinical scenarios where arterial perfusion is compromised during ECMO or ECLS support. The following conditions may warrant the use of this procedure:
The procedure for creating a graft conduit involves several critical steps to ensure successful arterial perfusion. Each step is outlined as follows:
Following the procedure, patients are typically monitored closely for any signs of complications, such as bleeding or infection at the incision site. Continuous assessment of limb perfusion is essential to ensure that the graft conduit is functioning effectively. Patients may require additional imaging studies to evaluate the patency of the graft and the adequacy of arterial flow. Recovery protocols will vary based on the patient's overall condition and the complexity of the ECMO/ECLS support being provided.
| Short Descr | ARTERY EXPOS/GRAFT ARTERY | Medium Descr | ARTERY EXPOS/GRAFT ARTERY PERFUSION ECMO/ECLS | Long Descr | 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) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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 an add-on code that must be used in conjunction with one of these primary codes.
| 33953 | MPFS Status: Active Code APC C Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age | 33954 | MPFS Status: Active Code APC C Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), open, 6 years and older | 33955 | MPFS Status: Active Code APC C 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 | 33956 | MPFS Status: Active Code APC C Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of central cannula(e) by sternotomy or thoracotomy, 6 years and older |
| 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.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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). | 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 | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study |
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| 2015-01-01 | Added | Added |
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