Cardiology Coding Alert

Hint: Physician can separately report extensive repair of an artery.

Don’t let the CPT^® guidelines for ECMO/ECLS trip you up. Take a look at the following tips to make sure you know exactly which codes you can and cannot report together when submitting your ECMO/ECLS claims.

Tip 1: The physician cannot separately report repositioning cannula(e) codes 33957 (Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age (includes fluoroscopic guidance, when performed))-33964 (… reposition central cannula(e) by sternotomy or thoracotomy, 6 years and older (includes fluoroscopic guidance, when performed)) at the same session as insertion codes 33951 (Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age (includes fluoroscopic guidance, when performed))-33956 (… insertion of central cannula(e) by sternotomy or thoracotomy, 6 years and older).

Tip 2: The physician can only report the replacement of ECMO/ECLS cannula(e) in the same vessel with the appropriate insertion code from the 33951-33956 range, according to the guidelines.

If the physician removes the cannula(e) from one vessel and places new cannula(e) in a different vessel, then he can report the appropriate cannula(e) removal code from the 33965 (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)-33986 (… removal of central cannula(e) by sternotomy or thoracotomy, 6 years and older) range and an insertion code from the 33951-33956 range.

If the physician performs extensive repair or replacement of an artery, he may also report those services. Some of these codes, for example, include blood vessel repair codes 35266 and 35286, thromboendarterectomy code 35371, and bypass graft code 35665.

Tip 3: If the physician uses fluoroscopic guidance for cannula(e) repositioning, codes 33957-33964, the guidance is considered part of the procedure, and he cannot separately report it.

Tip 4: The physician cannot report codes 33948 (Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; daily management, each day, veno-venous) and 33949 (… daily management, each day, veno-arterial) on the same day as codes 33946 (Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; initiation, veno-venous) and 33947 (… initiation, veno-arterial).

Tip 5: The physician cannot report codes 33946 or 33947 on the same day as codes 33957-33964.