ED Coding and Reimbursement Alert

Question: I have a tough coding choice to make. The physician performs initial-day ventilation management on a patient, but notes also indicate that she provided critical care service. What is the best way to code this encounter?

Missouri Subscriber

Answer: Your best bet is to go with the critical care, if the physician performed all of the components presented in the code descriptor.

CPT bundles all the ventilator management codes (94002-94004, 94660, 94662) into critical care, so you cannot file 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and a ventilator management code on the same claim. The decision you-ll need to make is whether to report 94002 (Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day) or the critical care code.

Do this: Check the notes. If the physician focused solely on ventilator management services during the session, consider 94002.

But if the notes describe an encounter in which the physician performs ventilation management in the course of a larger critical care service, report 99291. (Your question gives the impression that the physician performed and documented critical care services for at least 30 minutes, not just ventilation management.)

Benefit: Reimbursement for an upper-level E/M service like critical care is higher than reimbursement for the initial day of ventilator management.

-- Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.