Pulmonology Coding Alert

Careful: You should always bundle ventilator management codes with E/M.

Keep your encounter notes guarded and save about $100 by reporting mechanical ventilation management in critical care. In cases where documentation supports only the ventilator management service, drop the critical care code in favor of a ventilator management code -- or else risk denial.

Tackle These 3 Scenarios

Go for the most optimal solution when dealing with ventilator management claims. Knowing which details to focus on could do the trick.

Scenario 1: Your pulmonologist provides ventilator management. The progress notes describe the service as more in line with 99291. But you think 94003 is a better choice. What should you report?

Scenario 2: A hospital inpatient experiences acute respiratory failure, is intubated, and needs ventilator assistance to breathe. The pulmonologist evaluates the patient, and directs both the ventilator setup and the patient's first-day ventilator management. What should you report?

Scenario 3: A 67-year-old patient with obstructive chronic bronchitis and emphysema is seen in the hospital for increasing PaCO2 levels in spite of therapy. The pulmonologist orders nocturnal BiPAP to treat the patient. In this instance, the ICD-9 codes would be 491.21 (Obstructive chronic bronchitis -- with exacerbation) for the obstructive chronic bronchitis and emphysema with an acute exacerbation.

What should you report?

Ready with your solutions? Turn to page 37 for answers.