ED Coding and Reimbursement Alert

Vent Management:

Can You Justify the Vent Management Code? Check Documentation Before You Bill

Published on Thu Feb 10, 2022

Hint: Critical care code may be better choice than 94002 in some cases.

When does vent management not justify the vent management code? The answer depends on several factors, including whether critical care occurred during the encounter.

Here’s why: If your physician provides initial-day ventilation management services in the course of treating a critically ill or injured patient, be sure you choose the critical care code instead of a ventilation management code or you may not be following the CPT^®guidance. When your emergency physician provides ventilation management, it is usually for a patient requiring high-level ED evaluation and management (E/M) service, subsequent hospital care, or typically in most cases, even critical care.

That’s because ventilation management, when performed, is bundled into the critical care code. These E/M codes are a more accurate representation of the high complexity multi-faceted evaluation and patient management that is being provided.

Read on to get the scoop about reporting ventilation, critical care, ED E/M codes, and other possible scenarios in the emergency department.

E/M Documentation May Not Always Justify 94002-94003

Pulmonologists are the specialists most likely to use 94002 (Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day) and 94003 (... hospital inpatient/observation, each subsequent day). However, it is possible the emergency physician will provide these services in certain isolated instances, and this has been particularly true during the COVID-19 pandemic.

Consider Reporting an E/M if the Physician Goes Beyond 94002, 94003

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.

The 2022 CPT^®parenthetical which follows the code descriptor also backs this up: “Do not report 94002-94004 in conjunction with E/M services 99202-99499.”

Here’s why: With few exceptions, the physician will provide a high-level ED E/M service (such as 99284, 99285 or 99291), which is a more appropriate representation of the additional cognitive work being performed beyond simply managing the ventilator settings.

Example: At 5 am, an emergency physician is called by the critical care unit to see a patient with congestive heart failure who has suffered acute respiratory failure and had been placed on a ventilator two hours earlier. The emergency physician performs a history and physical exam; and reviews lab work, blood gases, ongoing laboratory studies, and consultants’ notes and recommendations for ongoing treatment. The emergency physician documents ventilator settings and, based on the recent blood gases, makes an adjustment to the ventilator settings, along with the data necessary to provide the initial day of ventilator care; notes indicate 12 minutes of ventilator management.

In order to further stabilize this critically ill patient, the physician spends another 48 minutes providing critical care services including adjusting several intravenous vaso-active medications and changing the patient’s antibiotics.

Since the physician provided critical care for the patient, you would add up total session minutes (48 + 12 = 60) and report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the physician’s services.

Critical care is a better representation of the physician’s cognitive effort. In this case, the highly complex bedside work involved reviewing significant data for a critically ill patient and adjusting the ventilator setting. The more appropriate code choice is 99291.