2025 CPT code 33946
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Cardiovascular System Surgery Feed
Physician initiation of veno-venous extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS).
Modifiers may be applicable depending on the circumstances.Consult the CPT manual and payer guidelines for appropriate modifier use.
Medical necessity for ECMO initiation is established by the severity of the patient's respiratory or cardiopulmonary failure, which must be life-threatening or pose a substantial risk to the patient's life.The patient's condition should not be effectively managed by conventional respiratory support methods. The documentation must clearly justify the use of ECMO over other less invasive treatments.
The physician is responsible for the safe and effective initiation of the ECMO/ECLS circuit, including cannulation (if not performed by another provider), setting the initial parameters, and ensuring the system is functioning correctly before handing over to other care providers.The physician does not necessarily maintain ongoing daily management.
In simple words: The doctor starts a machine that helps the patient's lungs work. This involves putting in a tube, connecting it to a machine that adds oxygen to the blood and removes carbon dioxide, and setting the machine to work properly.This is only the setup; the doctor will need to do more to manage the patient's condition later.
This CPT code 33946 represents the physician's services in initiating veno-venous (VV) extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS).This involves cannula insertion (through a vein), establishing the ECMO/ECLS circuit, setting parameters (blood flow, gas exchange, etc.), and ensuring the system's initial functionality.It does not include the ongoing daily management of the circuit or the patient's overall care.This procedure is used to provide temporary respiratory support when the patient's lungs are unable to function adequately.
Example 1: A 65-year-old male presents with acute respiratory distress syndrome (ARDS) following a severe pneumonia infection.The physician initiates veno-venous ECMO to provide temporary respiratory support while the patient's lungs heal., A 22-year-old female experiences cardiac arrest following a motor vehicle accident.The physician initiates veno-arterial ECMO to provide both cardiac and respiratory support during resuscitation efforts., A 50-year-old male is undergoing lung transplantation.The physician uses veno-venous ECMO as a bridge to support lung function pre- and post-transplant.
Detailed operative report including description of the cannulation technique (site and approach), type of cannula used, hemodynamic and respiratory data before and after ECMO initiation, ECMO circuit parameters (blood flow, oxygen saturation, CO2 removal), and any complications encountered. Preoperative and postoperative assessments must also be documented.
** This code is only for the initiation of the ECMO/ECLS circuit.Separate codes exist for cannula insertion, daily management, and decannulation.The physician's role in ECMO management may vary depending on the clinical context and hospital protocols.