Pulmonology Coding Alert

Question: Since the code descriptors for 94656 and 94657 do not specify examining the patient or a need for documentation of a physical exam, can we make ventilator changes over the phone and bill 94656? Also, if my physician calls a ventilator-dependent post-op patient before midnight to manage the ventilator change, can I report 94656 before midnight and then report an in-patient consultation with 99251-99255?


Pennsylvania Subscriber

Answer: You can't report ventilator management services (94656-94657) that your pulmonologist supervises over the phone. The physician must provide a face-to-face service, assessing the patient, the available data and ventilator settings to ensure overall effectiveness of treatment. Based on these factors, the pulmonologist may make ventilator changes.

Documentation of ventilator management services does not require the documentation of the three key components (history, exam and medical decision-making) per se. It should, however, include the patient's current respiratory status, ventilator settings, adjustments in therapy, and any clinically relevant information that the physician thinks is necessary for communication.

The National Correct Coding Initiative bundles ventilator management codes 94656 (Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; first day) and 94657 (... subsequent days) into consultative services (99251-99255), subsequent hospital visits (99231-99233), and other E/M services including critical care (99291-99292).
 
If your physician provides a consultation, fulfilling all of the clinical and documentation requirements of consultations, and also initiates ventilator management, you should report only the consultation. If your pulmonologist initiates ventilator management on the first day, you can't report a consultation on the next day because the physician is already participating in the patient's care.