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36.4.14 Extracorporeal Membrane Oxygenation (ECMO)
ECMO is payable only in POS 3 (inpatient hospital) and the client should be monitored in the neonatal or pediatric intensive care unit.
Procedure codes 2-36822, 2-33960, and 2-33961 may be used when requesting reimbursement for prolonged extracorporeal circulation for cardiopulmonary insufficiency.
Procedure code 2-33960 or 2-33961 is limited to one per day, any provider.
Reimbursement is considered for, but not limited to, the following clinical indications:
• Persistent pulmonary hypertension.
•Meconium aspiration syndrome.
•Respiratory distress syndrome.
•Adult respiratory distress syndrome.
•Congenital diaphragmatic hernia.
•Sepsis.
•Pneumonia.
•Pre- and post-operative 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. Payment for ECMO services may be recouped if the services were provided in the presence of these conditions.
The initial 24 hours of ECMO should be submitted using procedure code 2-33960. Procedure code 2-33961 should be used for each additional 24 hours. Procedure code 2-33960 is denied as part of 2-33961 if submitted with the same date of service.
If insertion of cannula (procedure code 2-36822) for prolonged extracorporeal circulation for cardiopulmonary insufficiency is submitted with the same date of service as procedure code 2-33960 or 2-33961, by the same provider, the insertion of the cannula is denied, and the ECMO (procedure codes 2-33960 and 2-33961) is considered for reimbursement.
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