ECMO CPT Codes and Usage Overview

Extracorporeal Membrane Oxygenation (ECMO) is a critical life support system, and its billing involves specific CPT codes, this is a general guide;

1. ECMO Initiation

• 33946: Venoarterial (VA) ECMO initiation, including cannulation, membrane oxygenation, and initial management.
• 33947: Venovenous (VV) ECMO initiation, similar inclusions as above but for VV support.
  Note: These codes encompass surgical cannulation, circuit setup, and initial monitoring.

2. Daily Management

• 33948: Daily management of VA ECMO (24-hour period).
• 33949: Daily management of VV ECMO (24-hour period).
  Usage: Billed once per day for ongoing monitoring, adjustments, and care. Concurrent critical care codes (e.g., 99291) may apply if separately documented.

3. ECMO Discontinuation

• 33951: Discontinuation of ECMO, including decannulation and final assessments. Applies to all ECMO types and patients of any age.
  Note: If cannula removal is performed separately, code 36591 (central venous catheter removal) or 36835 (arterial catheter removal) might apply.

4. Additional Procedures

• Cannulation: Separate codes (e.g., 36821 for ECMO cannula insertion) may be used if not bundled with initiation codes.
• Repositioning/Replacement: 33951 may apply for repositioning, but check specific scenarios.
• ECLS (Extracorporeal Life Support): Codes 33946-33951 are used interchangeably for ECMO/ECLS.

Key Considerations

• Documentation: Clearly document ECMO type (VA/VV), duration, complications, and procedures.
• Modifiers: Use modifiers (e.g., -59) if distinct services are provided on the same day.
• Age: Most codes are age-neutral, but verify guidelines for pediatric/neonatal specifics.
• Updates: Always consult the latest CPT guidelines and payer policies for changes.

Example Billing Workflow

1. Day 1: 33946 (VA ECMO initiation) + 36821 (cannulation, if not included).
2. Subsequent Days: 33948 (daily management).
3. Final Day: 33951 (discontinuation).

Ensure alignment with clinical documentation and payer rules to avoid denials. Collaborate with coding specialists for complex cases.

• Perfusionist and ECMO specialist services: The continuous monitoring by non-physician staff (perfusionists, nurses, respiratory therapists) is not separately billable to CPT; it’s considered hospital service. The physician’s role in supervision and decision-making is what 33948/33949 capture. Ensure the physician’s documentation reflects collaboration with these ECMO specialists (e.g., “ECMO specialist reports pressures normal, no circuit issues; plan continued current flow rate”). This shows the physician’s oversight.

• Transition and termination of ECMO: On the day ECMO is weaned off, it’s important to document the weaning trial, the decision to discontinue, and the removal of cannulas. If the intensivist performs a trial off ECMO and manages parameters up until decannulation by a surgeon, the intensivist can still bill the daily management code, and the surgeon bills the removal. If the same physician discontinues ECMO and pulls cannulas, they might only bill the removal code – but if significant management occurred that day as well, one could consider both (again, payer-dependent and requires clear documentation).