Cardiology Coding Alert

Question: A provider documents replacement of an extracorporeal membrane oxygenation (ECMO) cannula but doesn’t specify the vessel involved. What codes may apply? Do I need to query for more information?

Connecticut Subscriber

Answer: You should query the provider for more information, as you need to know whether the ECMO cannula was inserted into the same vessel, which would signify replacement, and be reported with just insertion codes; or inserted into a different vessel, which would require reporting both removal and insertion codes. The cannula can be central or peripheral, which is also necessary information for selecting the most accurate code.

The codes for insertion include:

• 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))
• 33952 (… 6 years and older (includes fluoroscopic guidance, when performed))
• 33953 (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 (… 6 years and older)
• 33955 (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 (… 6 years and older)

The removal codes include:

• 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)
• 33966 (… percutaneous, 6 years and older)
• 33969 (Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; removal of peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age)
• 33984 (… 6 years and older)
• 33985 (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)
• 33986 (… 6 years and older)

Note that fluoroscopy use is included in the procedure, so don’t code that service separately.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC