2025 CPT code 33964
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Cardiovascular System Surgery Feed
Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition central cannula(e) by sternotomy or thoracotomy, 6 years and older (includes fluoroscopic guidance, when performed).
Modifiers may be applicable depending on the circumstances of the procedure.Consult the CPT manual for appropriate modifier usage. For instance, modifier 22 might be used if the repositioning is significantly more extensive than usual, and modifier 51 could be used if additional procedures are done on the same day.
Medical necessity is established by documented evidence of suboptimal cannula position leading to compromised oxygenation or blood flow in the ECMO circuit. The repositioning must be deemed necessary to improve the effectiveness of ECMO/ECLS support and ultimately improve patient outcomes.
The physician is responsible for all aspects of the procedure, including pre-operative planning, cannula repositioning (sternotomy or thoracotomy approach), use of fluoroscopy (if needed), and post-operative care.
In simple words: The doctor moves a tube used in a heart-lung machine (ECMO/ECLS) in a child six or older, using an open surgery approach (cutting through the breastbone or chest).This helps the machine work better.A live X-ray image may be used to guide the process.
This CPT code, 33964, represents the physician's services in repositioning a central cannula for extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) in patients aged six years and older.The procedure involves an open approach via sternotomy or thoracotomy, and includes fluoroscopic guidance if used. The repositioning addresses the cannula's placement within the central vein, aiming for optimal blood flow and gas exchange within the ECMO/ECLS circuit.The physician's responsibility encompasses the entire process, from incision and cannula manipulation to closure of the surgical site. This code should not be reported with codes 32100, 39010, 33946, 33947, 33957, 33958, 33959, 33962, or 33963.
Example 1: A 7-year-old child with severe respiratory failure requires ECMO support.The initial cannula placement proves suboptimal, leading to poor oxygenation.The physician performs a sternotomy to reposition the cannula for improved blood flow and gas exchange, using fluoroscopic guidance.Code 33964 is reported., An 8-year-old patient on ECMO experiences a dislodged cannula. A thoracotomy is necessary to reposition the cannula.Code 33964 is reported, along with appropriate codes for the thoracotomy incision and closure., A 10-year-old patient requires ECMO cannula repositioning due to clotting around the cannula site. The physician performs a sternotomy and utilizes fluoroscopy to guide repositioning and restore efficient blood flow. Code 33964 is used.
Detailed operative report including: indication for repositioning, approach (sternotomy or thoracotomy), description of cannula repositioning technique, use of fluoroscopy (if used), and post-operative course.Pre-operative and post-operative imaging should be documented.
** This code is specific to patients six years and older.For younger patients, use code 33963.
- Revenue Code: P2F (MAJOR PROCEDURE, CARDIOVASCULAR - OTHER)
- Payment Status: Active
- Modifier TC rule: This code doesn't typically involve a technical component, as it's considered a complete physician service, with the surgical component inherently included.
- Specialties:Cardiothoracic Surgery, Cardiovascular Surgery, Pediatric Cardiac Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center