2025 CPT code 33957
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Cardiovascular System Surgery Feed
Repositioning of peripheral (arterial and/or venous) cannula(e) for ECMO/ECLS in a child aged birth to 5 years, percutaneous approach, including fluoroscopic guidance.
Modifiers such as 59 (distinct procedural service) may be applicable if additional services were performed on the same day.Modifier 22 (increased procedural service) is possible if the repositioning was significantly more complex than usual.
Medical necessity for ECMO/ECLS and cannula repositioning should be documented based on clinical indicators such as severe respiratory or cardiac failure that is unresponsive to other therapies and deemed reversible with ECMO/ECLS support.Documentation should justify the need for repositioning (e.g., malposition, occlusion, kinking).
The physician is responsible for the percutaneous access, repositioning of the cannula, ensuring proper placement within the vessel, and management of any complications arising from the procedure.This may include use of fluoroscopy for guidance.
In simple words: This code describes a doctor's work to readjust a small tube (cannula) used for a heart-lung machine (ECMO/ECLS) in a child under 5. The tube helps the child's heart and lungs while they are sick. The doctor makes a small opening in the skin to reposition the tube, and might use X-ray guidance to help.
This CPT code, 33957, encompasses the physician's services in repositioning peripheral arterial and/or venous cannulae via a percutaneous approach during extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) in pediatric patients aged birth through 5 years.The procedure involves accessing the cannula percutaneously, cleaning the insertion site, and carefully repositioning the cannula within the vessel. Fluoroscopic guidance, if utilized, is included in the code. This does not include the initial insertion of the cannula.
Example 1: A 2-year-old child on ECMO for respiratory failure requires repositioning of a malpositioned peripheral venous cannula. The physician performs the percutaneous repositioning under fluoroscopic guidance., A neonate undergoing ECMO support for congenital heart disease experiences a dislodged arterial cannula.The physician repositions the cannula using a percutaneous approach., A 4-year-old patient on ECMO after severe pneumonia requires repositioning of a peripheral venous cannula due to kinking. The physician performs the repositioning without fluoroscopy.
Complete medical history of the patient, including the reason for ECMO/ECLS. Pre-procedure assessment, including imaging studies if performed. Detailed operative note including approach, cannula location, and any complications. Post-procedure assessment, including imaging studies to confirm proper cannula placement.
** This code is specific to pediatric patients (birth-5 years). The use of fluoroscopy is implied if performed and does not require separate billing. Repositioning in the same vessel does not allow separate coding. Replacement of cannulae in a different vessel would require the use of removal and insertion codes.
- Payment Status: Active
- Modifier TC rule: This code does not have a technical component (TC) modifier.
- Specialties:Cardiothoracic Surgery, Pediatric Cardiology, Critical Care Medicine, Neonatology
- Place of Service:Inpatient Hospital, Pediatric Intensive Care Unit