CPT 33989 Left Heart Vent Removal Reimbursement | OpenPayer

Summary & Overview

CPT 33989: Removal of Left Heart Vent Catheter During ECMO/ECLS

CPT code 33989 represents the surgical removal of a left heart vent catheter via thoracic incision (sternotomy or thoracotomy) performed as part of extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS). This code documents a specific operative component of ECMO/ECLS care, a high-acuity intervention used in critical cardiopulmonary failure. Nationally, accurate coding of ECMO-related procedures supports clinical documentation, resource tracking, and appropriate payment for complex cardiothoracic services.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes how CPT code 33989 is used in clinical and billing workflows and provides context for payers and providers dealing with ECMO/ECLS episodes of care.

Readers will learn the clinical context of the procedure, typical sites of service, and the role of the code in documenting ECMO/ECLS surgical management. The report also outlines benchmarking and policy-relevant considerations where available. Data not available in the input will be noted as such.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 33989ECMOECLSthoracotomysternotomycardiothoracic surgeryvent catheter removalinpatient surgeryoperative procedure

Billing Code Overview

CPT code 33989 describes the surgical removal of a left heart vent catheter through a thoracic incision, such as a sternotomy or thoracotomy. The service is provided as part of extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS), therapies that use specialized machines to temporarily assume the work of the heart and lungs to allow organ recovery.

Service type: Surgical removal of left heart vent catheter as part of ECMO/ECLS
Typical site of service: Inpatient thoracic operating room or other operative setting requiring a sternotomy or thoracotomy

Clinical & Coding Specifications

Clinical Context

A 28-year-old patient with severe refractory respiratory failure and cardiogenic shock is supported on venoarterial extracorporeal membrane oxygenation (ECMO) with a left ventricular vent catheter placed via median sternotomy at the time of initial cannulation. After myocardial recovery and hemodynamic stabilization, the cardiothoracic surgery team performs removal of the left heart vent catheter through the prior thoracic incision in the operating room under general anesthesia. The clinical workflow includes preoperative review of ECMO settings and anticoagulation status, multidisciplinary discussion with perfusion and critical care teams, temporary reduction or cessation of anticoagulation per protocol, operative removal of the vent catheter through the sternotomy or thoracotomy incision, inspection for bleeding, chest closure or management of drains, and postoperative transfer to the intensive care unit for ongoing ECMO management or decannulation planning if appropriate. Documentation includes indication for vent removal, time and place of service, anesthesia and surgeon details, anticoagulation management, vent site findings, estimated blood loss, and any complications.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (neutral)	Use when no specific modifier applies and standard reporting is intended.

CPT 33995: Percutaneous Right Heart Ventricular Assist Device Insertion

CPT-33988-LEFT-HEART-VENTING-CATHETER-ECMO-ECLS

CPT 33988: Left Heart Venting Catheter Placement During ECMO/ECLS

CPT-33992-PERCUTANEOUS-LEFT-VENTRICULAR-ASSIST-DEVICE-REMOVAL

CPT 33992: Percutaneous Left Ventricular Assist Device Removal

CPT-33974-INTRA-AORTIC-BALLOON-REMOVAL-ASCENDING-AORTIC-REPAIR

CPT 33974: Removal of Intra–Aortic Balloon with Ascending Aortic Repair

CPT-33968-INTRA-AORTIC-BALLOON-REMOVAL-PERCUTANEOUS

CPT 33968: Percutaneous Intra-Aortic Balloon Removal

CPT-33971-INTRA-AORTIC-BALLOON-REMOVAL-FEMORAL-ARTERY-REPAIR

CPT 33971: Intra–Aortic Balloon Removal with Femoral Artery Repair

CPT-33980-VENTRICULAR-ASSIST-DEVICE-EXPLANTATION-SINGLE-VENTRICLE

CPT 33980: Ventricular Assist Device Explantation, Single Ventricle

CPT-33976-VENTRICULAR-ASSIST-DEVICE-IMPLANTATION

CPT 33976: Ventricular Assist Device (VAD) Implantation

CPT-33965-PEDIATRIC-EXTRACORPOREAL-CANNULA-REMOVAL

CPT 33965: Peripheral Cannula Removal for Extracorporeal Circulation, Pediatric

CPT-33978-VENTRICULAR-ASSIST-DEVICE-EXPLANTATION

CPT 33978: Ventricular Assist Device Explantation

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Taxonomy Code	Specialty	Notes
208100000X	Cardiovascular Thoracic Surgery	Primary specialty performing thoracotomy/sternotomy and vent removal.
208000000X	Cardiac Surgery	Surgeons focused on operative management of ECMO-related cardiac procedures.
207R00000X	Critical Care Medicine	ICU physicians involved in pre/postoperative management of ECMO patients.
363L00000X	Perfusionist	Perfusion specialists manage ECMO circuit during procedure (taxonomy used for non-physician providers).
207K00000X	Pulmonary Disease	Pulmonologists involved when respiratory failure is primary indication and in multidisciplinary planning.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I46.9`	Cardiac arrest, cause unspecified	Cardiac arrest can precipitate need for ECLS/ECMO and ventricular venting during support.
`I21.9`	Acute myocardial infarction, unspecified	Severe myocardial infarction with cardiogenic shock may require ECMO and left heart venting.
`I50.9`	Heart failure, unspecified	Acute decompensated heart failure with refractory hemodynamics can lead to ECMO support and vent placement/removal.
`J96.00`	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	Severe respiratory failure is a common indication for veno-venous ECMO and related procedures.
`T82.8XXA`	Other complications of cardiac and vascular prosthetic devices, implants and grafts, initial encounter	Complications related to cannulae or vent catheters may necessitate operative removal.
`Z45.2`	Encounter for adjustment and management of extracorporeal membrane oxygenation (ECMO)	Codes for encounters related to ECMO management and procedures such as vent removal.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33990`	Removal of venous catheter from heart through thoracic incision (part of ECMO/ECLS)	Performed for removal of venous cannula when explanting ECMO circuit; often performed in same operative session as left heart vent removal.
`33991`	Removal of arterial catheter from heart through thoracic incision (part of ECMO/ECLS)	Used when arterial cannula removal is required through thoracic incision and may be coordinated with vent removal.
`33992`	Central venous cannula removal in chest associated with ECLS/ECMO (other)	May apply for removal of additional central cannulas during ECMO decannulation.
`33993`	Explantation of extracorporeal membrane oxygenation (ECMO) circuit components	Used when formal explantation of ECMO circuit components is performed; vent removal can be a component of explantation.
`32551`	Tube thoracostomy, includes water-seal (eg, chest tube)	Often placed or managed intraoperatively when chest is opened or to manage postoperative pleural drainage after vent removal.
`99100`	Anesthesia for patient of extreme age, under 1 year or over 70 years — example of anesthesia add-on	Anesthesia considerations are integral; anesthesia-related modifiers or codes may be used per payer rules.

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