CPT® Code 33952

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older (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 experiencing severe heart and lung failure. 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 before being returned to the patient's bloodstream, either to the venous system or a major artery. In pediatric patients, particularly neonates and children, ECMO/ECLS is often performed through the percutaneous insertion of a dual lumen cannula into the right jugular vein. This cannula is designed with drainage holes positioned between the inferior vena cava (IVC) and the superior vena cava (SVC), while the return holes are located at the right atrium (RA). Alternatively, a two-cannula system may be utilized, where one catheter is inserted into the right femoral vein and advanced into the IVC, and the other is placed in the right internal jugular vein at the junction of the RA and SVC. The cannulation procedure is similar for both techniques, and the location of the jugular or femoral vein can be confirmed using ultrasound. The procedure involves puncturing the vein with a hollow needle, introducing a guidewire, and confirming placement with fluoroscopy. The vessel is then serially dilated to allow for the advancement of the cannula or introducer unit over the guidewire. Once the correct position 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. It is important to note that CPT® Code 33951 is designated for percutaneous peripheral cannula insertion in newborns up to 5 years old, while CPT® Code 33952 applies to patients aged 6 years and older.