CPT code 33953 is used for the insertion of a peripheral cannula for ECMO/ECLS, a procedure supporting heart and lung function.
CPT code 33953 is used to describe the insertion of a peripheral cannula for extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS). This procedure involves placing a cannula, which is a thin tube, into a peripheral blood vessel to facilitate the ECMO or ECLS process. ECMO/ECLS is a critical care technique used to provide prolonged cardiac and respiratory support to patients whose heart and lungs are unable to function adequately on their own. The peripheral cannulation approach typically involves accessing vessels in the limbs, such as the femoral artery or vein, to establish the necessary circulatory support.
For CPT code 33953, which involves the insertion of peripheral cannula for ECMO/ECLS, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier can be used if the procedure required significantly more work than typically required. This could be due to unusual procedural difficulties or patient complexities.
2. Modifier 51 (Multiple Procedures): If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was performed.
3. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It is particularly useful when procedures are not typically reported together but are appropriate under the circumstances.
4. Modifier 76 (Repeat Procedure by Same Physician): If the same procedure is repeated by the same physician, this modifier is used to indicate that the procedure was repeated.
5. Modifier 77 (Repeat Procedure by Another Physician): Similar to Modifier 76, but used when the procedure is repeated by a different physician.
6. Modifier 78 (Unplanned Return to the Operating/Procedure Room): This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
8. Modifier 80 (Assistant Surgeon): If an assistant surgeon is required for the procedure, this modifier is used to indicate their involvement.
9. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Similar to Modifier 80, but used when a qualified resident surgeon is not available.
10. Modifier 99 (Multiple Modifiers): If more than four modifiers are necessary to describe the service, this modifier indicates that multiple modifiers are applicable.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
The CPT code 33953 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set by the Medicare Administrative Contractor (MAC) for the region where the service is provided.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. If CPT code 33953 is listed on the MPFS, it indicates that Medicare has established a payment rate for this service, subject to any applicable conditions or limitations.
However, the final determination of reimbursement also involves the MAC, which is responsible for processing Medicare claims and making coverage decisions based on local policies. Each MAC may have specific guidelines or requirements that could affect whether CPT code 33953 is reimbursed in a particular jurisdiction.
Therefore, to ascertain if CPT code 33953 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and verify any additional coverage criteria or documentation requirements with their respective MAC. This ensures compliance with both national and local Medicare policies.
Discover the power of MD Clarity's RevFind software to ensure you're receiving every dollar you're owed. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 33953, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and safeguard your practice's financial health.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
