CPT® Code 33951

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age (includes fluoroscopic guidance, when performed)

Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) are terms that refer to a critical medical procedure used to provide long-term support for patients with severe heart and lung dysfunction. This procedure typically lasts from three to ten days and involves the use of an artificial lung to oxygenate blood outside the body. The process begins with the drainage of venous blood from a large central vein, which is then oxygenated and returned either to the venous system or a major artery, effectively bypassing the heart and lungs. In pediatric patients, particularly those from birth through five years of age, ECMO/ECLS is often performed through a percutaneous approach, which minimizes the need for open surgery. This involves the insertion of a dual lumen cannula into the right jugular vein, where the drainage holes are strategically placed between the inferior vena cava (IVC) and the superior vena cava (SVC), while the return holes are positioned at the right atrium (RA). Alternatively, a two cannulae system may be utilized, with one catheter inserted into the right femoral vein and advanced into the IVC, and the other placed in the right internal jugular vein at the junction of the RA and SVC. The procedure for cannulation is consistent across both techniques, and the use of ultrasound aids in locating the jugular or femoral vein. Following the puncture of the vein with a hollow needle, a guidewire is introduced, and its placement is confirmed via fluoroscopy. The vessel is then serially dilated to accommodate the cannula or introducer unit, which is advanced over the guidewire. Once the correct positioning is verified through fluoroscopy, the guidewire and introducer are removed, and the cannula is clamped. The previously primed ECMO/ECLS circuit is subsequently connected, initiating the life-sustaining treatment. The specific CPT® code 33951 is designated for the percutaneous insertion of peripheral cannula(e) in patients aged from birth to 5 years, while code 33952 applies to patients aged 6 years and older.