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6.3.23 Extracorporeal Membrane Oxygenation (ECMO)
ECMO may be effective on a short-term basis for patients with life-threatening respiratory and/or cardiac insufficiency.
Procedure codes 36822, 33960, and 33961 may be used when billing ECMO for clients with the following clinical indications (this is not an all-inclusive list):
• Persistent pulmonary hypertension
•Meconium aspiration syndrome
•Respiratory distress syndrome
•Adult respiratory distress syndrome
•Congenital diaphragmatic hernia
•Sepsis
•Pneumonia
•Preoperative and postoperative congenital heart disease or heart transplantation
•Reversible causes of cardiac failure
•Cardiomyopathy
•Myocarditis
•Aspiration pneumonia
•Pulmonary contusion
•Pulmonary embolism
Terminal disease with expectation of short survival, advanced multiple organ failure syndrome, irreversible central nervous system injury and severe immunosuppression are contra-indications to ECMO. Claims for ECMO services may be recouped if the services are provided in the presence of these conditions.
The initial 24 hours of ECMO should be submitted using procedure code 33960. Procedure code 33961 should be used for each additional 24 hours. Procedure code 33960 is denied as part of procedure code 33961 if submitted with the same date of service. Procedure codes 33960 and 33961 are limited to one per day when billed by any provider.
If insertion of cannula (procedure code 36822) for prolonged extracorporeal circulation for cardiopulmonary insufficiency is submitted by the same provider with the same date of service as procedure code 33960 or 33961, the insertion of the cannula is denied, and the ECMO (procedure codes 33960 and 33961) is considered for reimbursement.
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