ED Coding and Reimbursement Alert

Question: What documentation is necessary when reporting vent management?

Codify Subscriber

Answer: The ED physician should record the ventilator settings and adjustments. This includes the initial or current vent settings, any changes to those, and recommendations and/or orders relating to the vent setting changes.

Once you know how your physician administered the ventilation, look at when he administered the treatment. The codes are based on whether you’re reporting the first day of ventilation or subsequent days, but in the ED you’re typically only likely to report the first day unless the patient is moved into observation care for subsequent days.

Example: A patient has respiratory failure superimposed on congestive heart failure. Your ED physician examines the patient, reviews the pertinent data including chest X-rays, and orders the ventilator settings. He then writes a note describing what he’s done, documenting all the ventilator settings and how to monitor the patient including measuring arterial blood gases.

You should report 94002 (Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day) for the first day of the ventilation and, if your patient’s stay transcends two or more days in the ED, 94003 (… hospital inpatient/observation, each subsequent day) for subsequent days. Link the code to J96.00 (Acute respiratory failure, unspecified whether with hypoxia or hypercapnia) for the acute respiratory failure and I50.9 (Heart failure, unspecified) for the congestive heart failure, unless documentation supports more specific codes. However, keep in mind that these services are bundled with critical care.

Remember this: If the ED physician initiates only continuous positive airway pressure (CPAP) on an intubated patient, you should select 94660 (Continuous positive airway pressure ventilation (CPAP), initiation and management). But if the physician initiates negative pressure ventilation, you should use 94662 (Continuous negative pressure ventilation (CNP), initiation and management).