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CPT®
36822

CPT® Code 36822
Deleted

Code deleted, see 33951, 33952, 33953, 33954, 33955, 33956

Official Description

Insertion of cannula(s) for prolonged extracorporeal circulation for cardiopulmonary insufficiency (ECMO) (separate procedure)

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 36822 involves the insertion of cannulae for prolonged extracorporeal circulation, specifically for patients experiencing cardiopulmonary insufficiency. This procedure is a separate intervention that facilitates extracorporeal membrane oxygenation (ECMO), a critical life-support technique used in cases of severe cardiorespiratory failure. ECMO serves as a modified form of heart-lung bypass, allowing the heart and/or lungs to rest and recover while providing necessary oxygenation to the blood. The process involves the use of an artificial lung or membrane, which is situated outside the patient's body, to oxygenate the blood before it is returned to the circulatory system. The ECMO system comprises several key components, including a blood pump, tubing, a venous reservoir, a membrane oxygenator, and a countercurrent heat exchanger. These components work together to ensure that blood is effectively oxygenated and circulated. The cannulae, which are inserted into large blood vessels near the heart, such as those in the neck or femoral region, play a crucial role in connecting the patient to the ECMO machine. The insertion of these cannulae can be performed through various approaches, including a neck incision to access the veins or a direct approach to the heart by opening the chest. This procedure is vital for patients who require temporary support for their heart and lungs, allowing for recovery or maturation of these organs in critical situations.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The insertion of cannulae for prolonged extracorporeal circulation using ECMO is indicated for patients experiencing severe cardiopulmonary insufficiency. This condition may arise from various underlying issues, including but not limited to:

  • Cardiac Failure: Severe heart dysfunction that impairs the heart's ability to pump blood effectively.
  • Respiratory Failure: Conditions that severely compromise lung function, preventing adequate oxygenation of the blood.
  • Severe Pneumonia: A critical lung infection that can lead to respiratory distress and failure.
  • Acute Respiratory Distress Syndrome (ARDS): A serious condition characterized by widespread inflammation in the lungs, leading to significant breathing difficulties.
  • Cardiac Surgery Recovery: Patients recovering from complex cardiac procedures who require temporary support for their heart and lungs.

2. Procedure

The procedure for the insertion of cannulae for ECMO involves several critical steps to ensure proper placement and functionality. Each step is essential for the successful establishment of extracorporeal circulation.

  • Step 1: The procedure begins with the selection of appropriate access sites for cannula insertion. This may involve choosing large veins in the neck or femoral vessels, depending on the patient's condition and the clinical judgment of the healthcare provider.
  • Step 2: For a neck approach, an incision is made in the neck to access the selected vein. The vein is carefully incised to allow for the insertion of the cannula. The cannula is then guided through the vein and positioned into the right side of the heart, ensuring that it is correctly placed for optimal blood flow.
  • Step 3: A second cannula is inserted, which may be placed into the carotid artery in the neck or into the femoral artery. This cannula serves to return oxygenated blood back to the body, completing the circuit necessary for ECMO support.
  • Step 4: In cases where direct access to the heart is required, the chest is opened surgically. Cannulae are then inserted directly into the right atrium of the heart. This approach may be necessary for patients with specific anatomical considerations or when rapid access is required.
  • Step 5: Once the cannulae are in place, they are connected to the ECMO machine. This connection allows for the initiation of extracorporeal circulation, where blood is drawn from the body, oxygenated through the artificial lung, and then returned to the patient.

3. Post-Procedure

After the insertion of cannulae for ECMO, patients require close monitoring and care to ensure the effectiveness of the procedure and to manage any potential complications. Post-procedure care includes monitoring vital signs, assessing the function of the ECMO machine, and ensuring that the cannulae remain patent and properly positioned. Patients may experience a range of responses, and healthcare providers must be vigilant for signs of bleeding, infection, or thrombosis at the cannula insertion sites. Additionally, the patient's overall clinical status will be evaluated regularly to determine the need for ongoing ECMO support or the potential for weaning off the machine as their condition improves.
Short Descr INSERTION OF CANNULA(S)
Medium Descr INSJ CANNULA PROLNG XC-CIRCJ ECMO SPX
Long Descr Insertion of cannula(s) for prolonged extracorporeal circulation for cardiopulmonary insufficiency (ECMO) (separate procedure)
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 9 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Inpatient Procedures, not paid under OPPS
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P2F - Major procedure, cardiovascular-Other
MUE Not applicable/unspecified.
CCS Clinical Classification 50 - Extracorporeal circulation auxiliary to open heart procedures
Date
Action
Notes
2015-01-01 Deleted Code deleted, see 33951, 33952, 33953, 33954, 33955, 33956
Pre-1990 Added Code added.
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