CPT® Code 33946

Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) are terms that refer to advanced medical procedures used to provide long-term support for patients with severe heart and lung dysfunction. These procedures typically last from three to ten days and involve the circulation of blood outside the body through an artificial lung, which oxygenates the blood before returning it to the patient's bloodstream. In the case of veno-venous (V-V) ECMO/ECLS, blood is drawn from a large central vein, oxygenated, and then returned to the venous system. This method is particularly useful for patients whose lungs are unable to provide adequate oxygenation. Conversely, veno-arterial (V-A) ECMO/ECLS involves drawing blood from a central vein and returning it to a major artery, which is beneficial for patients with both cardiac and respiratory failure. The initiation of ECMO/ECLS is a complex process that requires a thorough evaluation of the patient's condition, including various diagnostic tests such as laboratory analyses, imaging studies like X-rays, and echocardiograms. Additionally, a neurological assessment may be performed, especially in neonates. It is essential to obtain informed consent from the patient or their family prior to the procedure. The setup involves preparing the necessary equipment, including the ECMO pump, anticoagulation (ACT) machine, and associated tubing, as well as ensuring that the ECMO bed is ready. Medications and blood products are also procured to support the patient's needs during the procedure. Once all preparations are complete and the medical team is in position, cannulation of the vessels is performed, allowing for the commencement of ECMO/ECLS therapy. The initiation of V-V ECMO/ECLS can be performed by qualified healthcare professionals such as neonatologists, pediatric intensivists, surgeons, or interventional cardiologists, with continuous monitoring provided by a perfusion specialist around the clock. The specific CPT® code 33946 is designated for billing physician services related to the initiation of V-V ECMO/ECLS, while CPT® code 33947 is used for V-A ECMO/ECLS initiation.