Pulmonology Coding Alert

Respiratory care departments: New codes 94644-94645 also apply to you Your ventilator coding just got easier thanks to CPT 2007's creation of four site-specific management codes.

But that's not all. Pulmonary medicine coders will have their hands full learning the nuances of 13 new codes. "Ventilator management has the greatest impact as the old (payable) ones have been replaced with new (payable) ones," says Carol Pohlig, BSN, RN, CPC, ASC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia. "Some of the other services may capture additional work but on a more limited basis." 

The AMA splits the pulmonary sub-section of CPT's Medicine section into two sub-subsections for "ventilator management" and "other procedures." New pulmonary codes will be added for site-specific ventilator management, surfactant administration, continuous bronchodilator inhalation and pediatric home apnea monitoring. This overhaul is coupled by a new code for tumor ablation therapy.

Don't worry: Experts share the rationale on these changes and give you the details you need to start using these codes this winter.
 
Follow 2 Rules When Coding Ventilator Mgt CPO CPT 2007 will also provide you with a way to code home ventilator management.

New monthly CPO code: For each month of 30 minutes or more of home ventilator management care plan oversight (CPO), you will be able to report 94005, which includes:

• review of status

• review of laboratories and other studies

• revision of orders and respiratory care plan (as appropriate). When using 94005 (Home ventilator management care plan oversight of a patient [patient not present] in home, domiciliary or rest home [e.g., assisted living] requiring review of status, review of laboratories and other studies and revision of orders and respiratory care plan [as appropriate], within a calendar month, 30 minutes or more), remember these rules:

Rule 1: Don't report this service when performed by the same physician/group along with other home (99339-99340) or home health agency, hospice or nursing facility (99374-99378) CPO services, according to the parenthetical instruction following 94005 in the CPT 2007 manual.

Rule 2: You can still use 94005 when another physician concurrently provides CPO during the same period. Downside: Medicare has not deemed this as an allowable, reimbursable service as of yet. Base Daily Vent Code on POS, Day For ventilator management in the hospital or nursing facility, you should use new codes 94002-94004, which replace deleted codes 94656 and 94657. The pulmonary medicine specialty societies requested a relative value unit change to 94657, notes CMS in the proposed notice on the work relative value units five-year review. But the Relative Update Committee (RUC) "determined that a rank order anomaly would be created with 94656 if the recommended value for CPT code 94657 was adopted," according to page 106 of [...]