Pulmonology Coding Alert

Question: I have a tough coding choice to make. The pulmonologist performs initial-day ventilation management on a new patient at the hospital, but notes also indicate a full initial hospital care service. Can I report vent management with an E/M?

Missouri Subscriber

Answer: Your best bet is to go with the E/M code, if the pulmonologist performed all of the components presented in the code descriptor.

CPT bundles all the ventilator management codes (94002-94004, 94660, 94662) into E/M codes, so you cannot file an E/M and ventilator management code on the same claim. The decision you'll need to make is whether to report 94002 (Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/ observation, initial day) or the appropriate E/M code.

Do this: Check the operative notes; if the pulmonologist focused solely on ventilator management services during the session, choose 94002.

But if the notes paint the picture of an encounter in which the physician performs ventilation management in the course of a larger E/M service, report the E/M code. (Your question gives the impression that the pulmonologist performed a full E/M, not just ventilation management).

Again, you should check the notes just to be sure that the pulmonologist performed all the components of initial hospital care. Because the initial hospital care represents the most comprehensive service and the overall intent of care provided on that day, it is best to report the most appropriate initial care code (99221-99223: Initial hospital care, per day, for the evaluation and management of a patient, which requires these three key components ...) for this encounter.

Reimbursement for a level-two or -three initial hospital care visit is higher than the reimbursement for the initial day of ventilator management to represent more physician effort.