ED Coding and Reimbursement Alert

Question: A 65-year-old inpatient in the hospital's intensive care unit (ICU) goes into acute respiratory failure. The nurse practitioner (NP) calls an ED physician to the unit to urgently intubate the patient. The physician places the patient on a ventilator and then calls in a pulmonologist to manage the patient. The pulmonologist examines the patient, reviews pertinent clinical data, initiates and documents the ventilator settings. The pulmonologist also orders needed services to monitor the patient. Final diagnosis is acute respiratory failure. Can I code ventilation management for my ED physician's services?

Montana Subscriber

Answer: You should solely code for the ED physician's intubation service. On the claim, report the following:

31500 (Intubation, endotracheal, emergency procedure) for the intubation

518.81 (Other diseases of lung; acute respiratory failure) appended to 31500 to represent the patient's condition.

Explanation: Although the ED physician saw the patient first and placed him on a ventilator, the pulmonologist performed the bulk of the work for the ventilation management, so she would be the physician eligible to code 94002 (Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day).