Pulmonology Coding Alert

Question: The pulmonologist sees a hospital inpatient suffering from pulmolithiasis. The notes indicate that the physician instituted "BiPAP" to assist the patient's breathing. Should I report this ventilation service with 94002?

North Dakota Subscriber

Answer: There are various interfaces that ventilator support can be achieved (such as through mouth piece, or nasal, face or helmet mask), using a variety of ventilatory modes (e.g., volume ventilation, pressure support, bilevel positive airway pressure [BiPAP], proportional-assist ventilation [PAV], continuous positive airway pressure [CPAP]) with either ventilators dedicated to noninvasive ventilation (NIV) or those capable of providing support through an endotracheal tube or mask. In the inpatient setting, the patient consistently requires ventilation support as opposed to the outpatient setting where the patient may only require assistance with sleep apnea.

CPT 94002 (Ventilation assist and management,initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day) is not limited by the interfaces or modes utilized. Report 94002 with 518.89Alternatively, report 94660 for initiation and management of BiPAP (Other diseases of lung, not elsewhere classified) when the patient requires nightly assistance with OSA.