Master Coding Techniques When Billing for Ventilator Management
Published on Mon Apr 01, 2002
A pulmonologist provides 40 minutes of bedside ventilator management to a patient in the intensive care unit of a hospital. This means he or she can bill for critical care services, right? Not necessarily.
Critical care codes (99291-99292) may be used if a long list of "ifs" is met. Otherwise, there are other billing options, such as ventilator management (94656-94657), the appropriate level of inpatient hospital services (99221-99223), or initial consultation services (99251-99255).
Don't Make These Four Mistakes
When caring for Medicare patients on ventilators, don't:
1. Use a critical care code simply because a patient is on a ventilator. The patient must meet CPT and CMS requirements for critical care.
2. Bill ventilator management separately from a critical care or E/M service.
3. Include procedures billed separately (e.g., thoracentesis, cardiopulmonary resuscitation [CPR]) as part of the critical care time used to bill the critical care code.
4. Bill a level-three E/M code for a stable patient just because he or she is on a ventilator. A detailed history or exam or medical decision-making of high complexity (two of these three components) is required to bill a level-three code.
Patient Must Meet Critical Care Guidelines
Critical care codes reimburse at a high rate. "Physicians and coders must understand the guidelines outlined in CPT and review these before billing," says Deborah Grider, CPC, CPC-H, CCS-P, coding specialist and president, Medical Professionals Inc. in Indianapolis. According to CPT, critical care is the direct delivery by a physician of medical care for a critical illness or injury that acutely impairs one or more vital organ systems to the extent that there is a "high probability of imminent or life-threatening deterioration in the patient's condition." This definition applies whether or not a patient is having a medical emergency.
Critical care involves high-complexity decision-making to assess, manipulate and support vital system functions to treat single or multiple vital organ system failure and/or prevent further life-threatening deterioration of the patient's condition. Examples of vital organ system failure include shock, or central nervous system, circulatory, renal, hepatic, metabolic and/or respiratory failure.
Billing Critical Care Codes
Ventilator management is bundled into 99291-99292 if the visit meets the billing threshold for time spent with the patient. To use 99291, the pulmonologist must spend 30 minutes or more with the patient. Code +99292 is billed for visits that exceed 74 minutes. This code is an "add-on" code and must be used with 99291.
To use these codes, however, the physician must devote his or her full attention to the patient during the time counted as the critical care service, although the time does not have to be continuous. Billable time is defined as anything from immediate bedside care to patient-related activities, such as reviewing test [...]
