New qualifiers were created in table 5A1, Physiological Systems, Performance, to capture percutaneous Extracorporeal Membrane Oxygenation (ECMO). The new codes enable additional detail to distinguish the different ECMO procedures that have grown over time with different indications, technical details and equipment designs.
The unspecified qualifier value “Membrane (3)” used only in a single ECMO code did not distinguish different ECMO procedures; therefore, code 5A15223 Extracorporeal Membrane Oxygenation, Continuous, has been deleted from ICD-10-PCS.
|5 Circulatory||2 Continuous||2 Oxygenation||F Membrane, Central
G Membrane, Peripheral Veno-arterial
H Membrane, Peripheral Veno-venous
ECMO is a bypass technique to support patients with reversible cardiopulmonary insufficiency unresponsive to conventional management. ECMO involves passing a patient’s blood through an extracorporeal membrane oxygenator, which pumps and oxygenates the blood outside the patient’s body, removing carbon dioxide. The goal of ECMO is to provide organ and tissue oxygenation during cessation of cardiac activity.
ECMO may be indicated for
- Refractory cardiogenic shock
- Fulminant myocarditis
- Patients recovering from heart failure, lung failure or heart surgery.
- As a bridge to further treatment, such as placement of a heart assist device, heart transplantation, or lung transplantation.
- For support during high-risk procedures in the cardiac catheterization lab
There are three types of ECMO that correspond to the new ICD-10-PCS qualifiers: Central, Venous-Arterial (VA) Peripheral and Venous-Venous (VV) Peripheral.
Central ECMO cannulation is an open-chest procedure with direct surgical cannulation of the right atrium and aorta. It involves two open insertions, arterial and venous, and provides cardiorespiratory support. In the past, central ECMO was more commonly used; however, peripheral ECMO is more common now. For central ECMO, assign code 5A1522F, Extracorporeal oxygenation, membrane, central.
VA peripheral ECMO cannulation involves two femoral percutaneous insertions: arterial and venous. The VA ECMO is used when there are problems with both the heart and lungs. This type of ECMO provides respiratory and circulatory support. Code 5A1522G, Extracorporeal oxygenation, membrane, peripheral veno-arterial, is used for VA peripheral ECMO.
VV ECMO involves two venous insertions, one in the upper veins and one in the lower veins. It is used when the problem is only in the lungs. Code 5A1522H, Extracorporeal oxygenation, membrane, peripheral veno-venous, is used for VV peripheral ECMO.
A patient with a history of cirrhosis secondary to alcohol dependence was admitted for liver transplant surgery. The hepatectomy was performed on veno-venous bypass. Cannulas were placed in the right femoral vein and the portal vein. The cannulas were connected to the circuit and veno-venous bypass was instituted at 2.5L per minute. What is the procedure code assignment for veno-venous bypass?
Assign the following procedure code:
5A1522H Extracorporeal oxygenation, membrane, peripheral veno-venous, for veno-venous bypass used during surgery
The patient presented with cardiogenic shock and ECMO support was provided at the bedside in the intensive care unit. The central jugular vein and the left femoral artery were cannulated and ECMO support initiated. What is the appropriate ICD-10-PCS code for this type of ECMO support?
Assign the following procedure code:
5A1522G Extracorporeal oxygenation, membrane, peripheral veno-arterialThe cannulations of both the jugular vein and the femoral artery indicate VA ECMO support.