Ecmo - I have never billed for this


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I have never billed for this before, but the dr did the cannula (36822) and the pt was on the machine for 2 days (33960,33961). I coded the daily codes but did not code the cannula because it says separate procedure. Is this correct? Is there a requirement of the dr being at the bedside for a certain amt of time or any special documentation requirements for the daily codes? Does he have to say "pt still on Ecmo" or anything llike that? Can the ECMO codes be billed with critical care codes?
Thanks a lot!!!
Separate procedure

ECMO is a separate procedure if it is NOT done as part of other heart/lung surgery.

In our setting (Pediatric hospital) the surgeon inserts the ECMO cannula; the intensivist is the one who is managing the ECMO. So one doctor bills the 36822; another doctor bills 33960/33961. Only one physician can bill the 33960/33961 code per day, so be sure the intensivist is not doing so. (The code is for 24 hours of care.)

Yes, you can bill critical care AND ECMO management on the same date of service (assuming your documentation support this). For critical care, the MD must be at bedside for a minimum of 30 minutes.

Documentation must reference ECMO each date, preferably with settings or some statement as to patient's repsonse to this.

Hope this helps.
F Tessa Bartels, CPC-E/M

That was a HUGE help! This is for an adult pt and the intensivist did the ECMO as well as managing it afterwards each day. He is new and we just started doing these.
Don't forget modifier

Don't forget your -25 modifier on critical care code if you are also billing ECMO management daily.

HOWEVER ... inserting the ECMO cannula - CPT 36822 - has a 90 day global period! So your ciritcal care codes would probably be considered global.

Can you post sanitized op notes / progress notes?

Feel free to call me - I'm in Wisconsin -

F Tessa Bartels CPC-E/M
thank you SO MUCH

I wrote down your number. We have intensivists who bill daily care post op in the SICU for things such as repiratory failure. This guy came here from Germany and this ECMO thing is totally new for our CT dept. Plus he is not used to our endless rules for documentation! So far he has been doing this at the bedside in the ICU. Thanks for all your help and have a GREAT 4th of July!!!
Sounds like you were correct

Without seeing the notes I can only guess, but it sounds as if you were correct in the way you billed (33960 first day / 33961 each subsequent day on ECMO).

Now, IF he had documentation to support critical care (with 30 minutes or more at bedside each day) then you can also bill that w/ -25 modifier on the critical care.

Feel free to call or email me at

F Tessa Bartels, CPC-E/M
Do you bill the first day the same day that the cannula is inserted or after the first 24 hours is up?

Is this the correct way a patient should be billed on ECMO for 36 hours and passed away on 7/8/08?
36822 done on 7/7/08
33960 billed 7/7/08
33961 billed on 7/8/08 with a 52 modifier