Cardiology Coding Alert

Question: I’m currently coding a case where two physicians were involved during an ECMO/ECLS procedure. One physician managed the circuit and the anticoagulation, and the other physician managed the patient’s overall condition and underlying disorders — on a daily basis. What are the rules when multiple physicians are involved in ECMO/ECLS?

New York Subscriber

Answer: In the case where multiple physicians are involved in ECMO/ECLS, usually the physicians are of different specialties and significant physician team interaction is usually necessary.

Rule: If the same physician provides any or all of the services for placing a patient on an ECMO/ECLS circuit, then he may report the appropriate codes for the service he performed, according to the CPT® guidelines. These codes are as follows:

• Cannula(e) 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)) through 33956 (Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of central cannula(e) by sternotomy or thoracotomy, 6 years and older)
• ECMO/ECLS initiation codes 33946 (Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; initiation, veno-venous) or 33947 (Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; initiation, veno-arterial)
• The appropriate evaluation and management (E/M) code for overall patient management.

Caution: The same or different individuals may not report 33948 or 33949 for ECMO/ECLS daily management and 33957-33964 for repositioning services on the same day as codes 33946 or 33947.

“If different physicians provide parts of the service, each physician may report the correct code(s) for the service(s) they provided, except as noted,” per the guidelines.