ED Coding and Reimbursement Alert

Question:  Our physician performed vent management on a critically ill patient. We reported 94002 and it was denied. Should we appeal?

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Answer: If your physician provides initial-day ventilation management services in the course of treating a critically ill or injured patient, you’ll report the critical care code instead of a ventilation management code, per CPT^® guidelines.

The reason: Ventilation management, when performed, is specifically bundled into the critical care code (and most other E/M codes); these E/M codes are a more accurate representation of the high complexity multi-faceted evaluation and patient management that is being provided.

“It should be noted that code 94002 may not be reported in conjunction with evaluation and management services 99201-99499,” according to the March 2007 CPT^® Assistant^®.

The 2019 CPT^® parenthetical which follows the code descriptor also backs this up: “Do not report 94002-94004 in conjunction with E/M services 99201-99499.”

If the notes indicate that the ED physician provided ventilation management in the course of a greater E/M service, you’ll want to be sure to bundle all of the encounter work and choose the proper E/M code.

Here’s why: With few exceptions, the physician will provide a high-level ED E/M service (such as 99285), which is a more appropriate representation of the additional cognitive work being performed beyond simply managing the ventilator settings.