Cardiology Coding Alert

Remember: There are 2 methods of ECMO/ECLS.

In the medical documentation, you read that the patient has a case of the severe flu, so he was put on ECMO/ECLS to help keep him alive while his body heals. You must ask yourself several questions to correctly code this case, including what method of ECMO/ECLS the cardiologist used and the age of the patient.

Read the following expert advice to confidently handle all of the ECMO/ECLS cases that come across your desk.

First, Define ECMO/ECLS for Clarity

Prolonged extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) gives sick or injured patients the recovery and rest time they need by providing them with cardiac and/or respiratory support for their heart and/or lungs.

“ECMO/ECLS supports the function of the heart and/or lungs by continuously pumping some of the patient’s blood out of the body to an oxygenator (membrane lung) where oxygen is added to the blood, carbon dioxide (CO2) is removed, and the blood is warmed before it is returned to the patient,” according to CPT^® guidelines.

In the past, the typical ECMO/ECLS patients were premature newborns, but this has changed in recent years to include adults, according to Theresa Dix, CCS-P, CPMA, CCC, ICDCT-CM, a coder and auditor from Knoxville, Tennessee.

ECMO/ECLS is now used as a means of temporary life support for patients with severe cardiac and/or respiratory failure, adds Carol Hodge, CPC, CDEO, CCC, CEMC, certified medical coder at St. Joseph’s Cardiology in Savannah, Georgia. Examples include respiratory failure, cardiogenic shock, failure to wean from cardiopulmonary bypass after cardiac surgery, a bridge to placement of a ventricular assist device, and cardiac transplant.

Discover 2 Methods of ECMO/ECLS

The two methods of ECMO/ECLS are veno-arterial and veno-venous.

You will typically see the following information in descriptors, according to Julie-Leah J. Harding, CPC, CPMA, CEMC, CCC, CRC, CPEDC, RMC, PCA, CCP, SCP-ED, CDIS, AHIMA-approved ICD-10 trainer and ambassador and director of revenue operations at Boston Children’s Hospital in Boston, Massachusetts:

• Veno-venous (VV) ECMO: This procedure takes blood from a vein and returns it to a vein. This type of ECMO supports lung function only.
• Veno-arterial (VA) ECMO: This procedure takes blood from a vein and returns it to an artery. VA ECMO supports both the heart and the lungs. It’s more invasive than VV ECMO. Sometimes the carotid artery (the main artery from the heart to the brain) may need to be closed off afterward.

Know Difference Between Daily Management Versus Daily Overall Management

To report daily ECMO/ECLS management, you will submit either 33948 (Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; daily management, each day, veno-venous) or 33949 (… veno-arterial).

The daily management of the ECMO/ECLS circuit and monitoring parameters requires physician oversight to ensure that specific features of the interaction of the circuit and parameters includes management of blood flow, oxygenation, CO2 clearance by the membrane lung, systemic response, anticoagulation and treatment of bleeding, and cannula positioning, alarms and safety, explains Cynthia A. Swanson RN, CPC, CEMC, CHC, CPMA, AAPC ICD-10-CM Proficient, AAPC Fellow, senior manager of healthcare consulting at Seim Johnson, LLP in Omaha, Nebraska.

On the other hand, you may separately report the daily overall management of the patient with relevant hospital observation codes, hospital inpatient services, or critical care evaluation and management (E/M) codes.

Some of these applicable E/M codes include but are not limited to the following:

• 99218 (Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: a detailed or comprehensive history; a detailed or comprehensive examination; and medical decision making that is straightforward or of low complexity)-99223 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and medical decision making of high complexity)
• 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: a problem focused interval history; a problem focused examination; medical decision making that is straightforward or of low complexity)-99236 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, which requires these 3 key components: a comprehensive history; a comprehensive examination; and medical decision making of high complexity)
• 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes)-+99292 (… each additional 30 minutes (List separately in addition to code for primary service))

Don’t forget: “The daily overall management of the patient is a factor that will vary greatly depending on the patient’s age, disease process, and condition,” per CPT^®.