Cardiology Coding Alert

Question: I’m new to cardiology and I’m confused about the difference between the codes for the daily patient’s extracorporeal membrane oxygenation (ECMO) management versus the codes for the patient’s daily overall management. Are these two different things?

Alabama Subscriber

Answer: Yes. You should report different codes for the daily patient’s ECMO management versus the patient’s daily overall management.

Daily ECMO management: To report daily ECMO management, you will report 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 circuit and monitoring parameters, codes 33948 and 33949, requires your physician’s oversight to make sure that the specific features of the interaction of the circuit with the patient are met. This includes the following:

• Management of blood flow;
• Oxygenation;
• CO₂ clearance by the membrane lung;
• Systemic response;
• Anticoagulation and treatment of bleeding; and
• Cannula positioning, alarms, and safety.

Daily overall management: On the other hand, you may separately report the daily overall management of the patient with the appropriate 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…)
• 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))

Caution: When considering the daily overall management of the patient, you must look for details in the documentation such as the patient’s age, the disease process, and the condition.