1. ECMO Coding Changes Karen Bridgeman, MSN, RN, CCDS CDI Educator
Medical University of South Carolina

2. Karen Bridgeman, MSN, RN, CCDS has been a Clinical Documentation Specialist for over ten years, and is the CDI Educator for the Medical University of South Carolina. In 2012, she developed and implemented the successful Pediatric CDI Program at the Medical University of South Carolina’s Children’s Hospital. She is a frequent contributor on pediatric subject matter for the ACDIS Journal and has presented at several ACDIS National Conferences. In addition, she is the author of the CDI Essential Skills Online Learning Library. She currently serves on ACDIS’s CCDS Certification Board.

3. What Is ECMO Extracorporeal Membrane Oxygenation (ECMO)
Extracorporeal means outside the body
A membrane oxygenator is a piece of equipment which acts as a lung to deliver oxygen into the child’s blood
The ECMO circuit acts as an artificial heart and lung for the patient during ECMO therapy
Pumps and oxygenate the blood outside the body, allowing the heart and lungs to rest

4. ECMO Circuit
Jürgen Schaub. de:User:Mr.Flintstone [CC BY-SA 2.0 de ( from Wikimedia Commons

5. Central Cannulation
Central cannulation is an open chest procedure or via thoracotomy or sternotomy
More common in infants with congenital heart defects
Central ECMO most commonly occurs in patients who are already in the operating room with their chest already open
Most commonly in patients when the heart has not recovered enough near the end of a cardiac surgical procedure and patient can not come off cardiopulmonary bypass
Copyrighted material used with permission of the author, University of Iowa Hospitals & Clinics, uihc.org.

6. Peripheral Cannulation
Insertion of cannula via femoral, cervical, or axillary vessels
Percutaneously or open surgical cutdown
Neonates most often cannulated through the neck
Although the peripheral cannulation method is different from central cannulation, the risks for both patients remain the same
Resources utilization is the same regardless of peripheral or central cannulation
It is the high acuity of illness and complexity of ECMO support that drives the cost of care
Mr.Flintstone [GFDL ( or CC-BY-SA-3.0 (

7. Veno-arterial (VA) ECMO Cardiac or Respiratory Failure
Veno-venous (VV) ECMO
Isolated Respiratory Failure
Van Meurs, K, Lally, KP, Peek, G, Zwischenberger, Extracorporeal Life Support Organization, Ann Arbor [CC BY 2.5 ( via Wikimedia Commons

8. ICD-10-PCS Codes ICD-10-PCS Code Title 5A1522F
Extracorporeal Oxygenation, Membrane, Central
5A1522G
Extracorporeal Oxygenation, Membrane, Peripheral Veno-arterial
5A1522H
Extracorporeal Oxygenation, Membrane, Peripheral Veno-venous
The ICD-10-PCS code set moved from a single code for ECMO to three separate PCS codes differentiated by the mode of vascular access or cannulation.
Peripheral cannulation is not regarded as a surgical procedure.
Peripheral cannulation greatly impacts reimbursement.

9. MS-DRG Grouper for ECMO
MDC
MS-DRG
MS-DRG Title
Weight
GLOS
ALOS
PRE
003
ECMO or Trach w MV >96 HRS or PDX Exc Face, Mouth & Neck w Maj O.R.
23.4
30.1
207
Respiratory System Diagnosis w Ventilator Support >96 HRS or Peripheral Extracorporeal Membrane Oxygenation (ECMO)
5.5965
12.0
13.9 05
291
Heart Failure & Shock w MCC or Peripheral Extracorporeal Membrane Oxygenation (ECMO)
1.3454
4.1
5.2
296
Cardiac Arrest, unexplained w MCC or Peripheral Extracorporeal Membrane Oxygenation (ECMO)
1.5355
2.0
3.2 18
870
Septicemia or Severe Sepsis w MV >96 HRS or Peripheral Extracorporeal Membrane Oxygenation (ECMO)
6.2953
12.4
14.4

10. Coding Clinic Percutaneous extracorporeal membrane oxygenation
ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD Pages: Effective with discharges: October 1, 2018
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.

11. APR-DRG Grouper for ECMO
Title
Weight
ALOS
004-1
Tracheostomy w MV 96 HRS w Ext Procedure or ECMO
5.0795
12.07
004-2
6.9107
20.01
004-3
25.83
004-4
Tracheostomy w MV 95 HRS w Ext Procedure or ECMO
37.75
APR-DRG
Title
Weight
ALOS
583-1
Neonate w ECMO
8.2379
22.50
583-2
9.1532
25.00
583-3
35.90
583-4
64.84

12. APR-DRG v35.0 Modification
Title
Weight
ALOS
009-1
Extracorporeal membrane oxygenation (ECMO)
5.5141
7.00
009-2
7.5019
6.71
009-3
13.95
009-4
29.91
Revised APR-DRG 004 Tracheostomy w MV 96 HRS w Extensive Procedure
Neonates 15+ days of life

13. Neonatal ECMO APR-DRG v35.0 vs. MS-DRG
Neonates 0 – 14 days of life on admission
DRG Grouper
Central Cannulation
Peripheral Cannulation
APR-DRG
APR-DRG 583 Neonate w ECMO
MS-DRG
MS-DRG 003 ECMO or Trach w MV >96 HRS or PDX Exc Face, Mouth, & Neck w Maj O.R.
MS-DRG
Dependent upon appropriate neonatal MS-DRG assignment
Neonates 15+ days of life on admission
DRG Grouper
Central Cannulation
Peripheral Cannulation
APR-DRG
APR-DRG 009 ECMO
Dependent upon principal diagnosis & DRG assignment
MS-DRG
MS-DRG 003 ECMO or Trach w MV >96 HRS or PDX Exc Face, Mouth, & Neck w Maj O.R.
MS-DRG
Dependent upon appropriate neonatal MS-DRG assignment

14. Pediatric ECMO APR-DRG v35.0 vs. MS-DRG
DRG Grouper
Central Cannulation
Peripheral Cannulation*
APR-DRG
APR-DRG 009 ECMO
APR-DRG 133 Respiratory Failure
MS-DRG
MS-DRG 003 ECMO or Trach w Vent >96 HRS or PDX EXC Face, Mouth & Neck w Maj O.R.
MS-DRG 207 Respiratory System Diagnosis w Ventilator Support >96 HRS or Peripheral Extracorporeal Membrane Oxygenation (ECMO)
*The DRG grouping for ECMO with peripheral cannulation
will be dependent upon the principal diagnosis and DRG assignment
For this example, the principal diagnosis would be acute respiratory failure.

15. Neonatal ECMO APR-DRG v32.0 vs. MS-DRG
Neonates 0 – 14 days of life on admission
DRG Grouper
Central Cannulation
Peripheral Cannulation
APR-DRG
APR-DRG 583 Neonate w ECMO
MS-DRG
MS-DRG 003 ECMO or Trach w MV >96 HRS or PDX Exc Face, Mouth, & Neck w Maj O.R.
MS-DRG
Dependent upon appropriate neonatal MS-DRG assignment
Neonates 15+ days of life on admission
DRG Grouper
Central Cannulation
Peripheral Cannulation
APR-DRG
APR-DRG 004 Trach w MV 96+ HRS w Ext Procedure or ECMO
APR DRG 004 Trach w MV 96+ w Ext Procedure or ECMO
MS-DRG
MS-DRG 003 ECMO or Trach w MV >96 HRS or PDX Exc Face, Mouth, & Neck w Maj O.R.
MS-DRG
Dependent upon appropriate neonatal MS-DRG assignment

16. Pediatric ECMO APR-DRG v32.0 vs. MS-DRG
DRG Grouper
Central Cannulation
Peripheral Cannulation
APR-DRG
APR-DRG 004 Trach w MV 96+ HRS w Ext Procedure or ECMO
MS-DRG
MS-DRG 003 ECMO or Trach w Vent >96 HRS or PDX EXC Face, Mouth & Neck w Maj O.R.
MS-DRG 207 Respiratory System Diagnosis w Ventilator Support >96 HRS or Peripheral Extracorporeal Membrane Oxygenation (ECMO)
For this example, the principal diagnosis would be acute respiratory failure.

17. Transfer in on ECMO
There is not an ICD-10-CM/PCS code to assign for the presence of ECMO on admission
When critically ill patients are transferred, the receiving hospital does not receive any compensation for the continuation of ECMO therapy.
Recommend to use code: Z Presence of heart assist device
This is a complication and co-morbidity (CC)
With a severity of illness (SOI) level 3 and risk of mortality (ROM) level 4
Since these critically ill patients will most likely have multiple CCs and/or MCCs, this in all likelihood will not impact the MS-DRG assignment
Will not fall into one of the five MS-DRG groupings for ECMO as cannulation occurred at the outside facility.

18. Tracking ECMO Patients

19. Any Questions?
Karen Bridgeman, MSN, RN, CCDS