CPT® Code 33953

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

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 a sophisticated system that takes over the function of the heart and lungs by circulating blood outside the body through an artificial lung, where it is oxygenated before being returned to the bloodstream. 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, depending on the specific clinical scenario. The insertion of peripheral arterial and/or venous cannulae is performed using an open surgical technique, which involves making an incision in the skin over the targeted vessel, such as the femoral or jugular vein. This incision allows the physician to dissect the underlying tissue to access the vessel directly. A small opening is created in the vessel, and a guidewire is introduced to facilitate the placement of the cannula. The correct positioning of the guidewire is confirmed through fluoroscopy, a real-time imaging technique that allows for precise placement. The vessel is then serially dilated to accommodate the cannula or introducer unit, which is advanced over the guidewire. Once the cannula is correctly positioned, the guidewire and introducer are removed, and the cannula is clamped to secure it in place. The ECMO/ECLS circuit, which has been pre-primed with a sterile solution, is then connected to the cannula, initiating the life-support treatment. Finally, the incisions made during the procedure are closed, and the tubing is secured to ensure stability and prevent dislodgment. This code, CPT® 33953, specifically applies to the insertion of peripheral cannulae in patients ranging from newborns to 5 years of age, while a different code, CPT® 33954, is designated for patients aged 6 years and older.