Anesthesia Coding Alert

Question: Our anesthesiologist intubated a patient for surgery. The patient was admitted to the intensive care unit (ICU) following surgery and was placed on a ventilator. An intensivist who is an anesthesiologist, but not the one involved with the surgical case, provided daily ICU care.
 
Can the intensivist bill for initial vent management in the ICU the day of surgery because he performed the admission workup, ensured the ventilator settings were correct and managed the patient's care? Can the intensivist bill another initial vent day if the patient is weaned from the vent but has to be put back on it because of respiratory distress? What if a different physician handles the second ventilation?

Michigan Subscriber

Answer: Although you don't mention it in your question, chances are the intensivist is reporting critical care codes for this case. Critical care codes pay more than vent codes, but the physician must also meet the time requirements before using these codes.
 
Report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the first 30-74 minutes of care (the patient's history and system-by-system physical with a care plan for each system). Use +99292 (... each additional 30 minutes [list separately in addition to code for primary service]) for additional 30-minute blocks. Remember: Any time spent with the patient must be carefully documented.
 
Check with your local carrier before billing for ventilator management because many ICU policies (such as New York) bundle it with critical care codes (CPT also bundles vent management into critical care codes). If you're able to bill vent management separately and the patient was intubated during care that was not anesthesia-related, report 31500 (Intubation, endotracheal, emergency procedure). You can still code for the re-intubation even if you are not reporting critical care codes. Append modifier -59 (Distinct procedural service) to 31500 if both intubations for the ventilator took place on the same day.

 - You Be the Coder and Reader Questions were provided by Barbara Johnson, CPC, MPC, a coder with Loma Linda University Anesthesiology Medical Group in Loma Linda, Calif.