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Pulmonology Coding Alert

Reader Questions:

ECMO

Published on Sun Dec 01, 2002

Question: How should I code ECMO?

Georgia Subscriber

Answer: Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary bypass technique. It provides long-term cardiac or respiratory support in patients with respiratory or cardiac insufficiency. Physicians often use this technology with newborns. Indications for usage can include meconium aspiration, pulmonary hypertension, and congenital diaphragmatic hernia in newborns. Pediatric patients with acute respiratory distress syndrome or pneumonia and adult patients who have undergone cardiac surgery or have other life-threatening problems also benefit from this technique.

ECMO is often used during the critical care period of newborns. For example, if a newborn has respiratory failure and enters into a critical care state, the physician may decide to use the ECMO technology. In this case, you would code 99295 (Initial neonatal intensive care, per day, for the evaluation and management of a critically ill neonate or infant) for the first day of care and 99296 (Subsequent neonatal intensive care ...) for subsequent days, along with 33960 (Prolonged extracorporeal circulation for cardiopulmonary insufficiency; initial 24 hours). Code +33961 (... each additional 24 hours) is an add-on code and is listed separately in addition to the primary code 33960. Beginning Jan. 1, 2003, remember to use the new neonatal critical care codes for ECMO.

Be sure to document the diagnosis code that will prove medical necessity, such as 518.81 (Acute respiratory failure). The ECMO code is not bundled in the neonatal intensive care codes, so you do need to code it separately. Append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the intensive care codes.

An additional code of importance is 36822 (Insertion of cannula[s] for prolonged extracorporeal circulation for cardiopulmonary insufficiency [ECMO] [separate procedure]). This code would be used in addition to code 33960 used for the ECMO process.

It is important to note that the Correct Coding Initiative version 8.3 bundles several new procedures into the ECMO code:

  • 36000* Introduction of needle or intracatheter, vein

  • 90780 Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour

  • Injection of anesthetic agent for somatic nerves (64415, 64417, 64450, 64470, 64475)

  • Injection of spinal cord (62318-62319)

  • 36410* Venipuncture, child over age 3 years or adult, necessitating physician's skill (separate procedure), for diagnostic or therapeutic purposes

  • 37202 Transcatheter therapy, infusion other than for thrombolysis, any type.

    Advice for You Be the Coder and Reader Questions was provided by Carol Pohlig, BSN, RN, CPC, at the University of Pennsylvania department of medicine in Philadelphia; and Anthony M. Marinelli, MD, FCCP, chairman of the American Thoracic Society's Clinical Practice Committee.

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