Boost reimbursement by 70% on subsequent care days with 9400x in lieu of low-level E/M. Time and Place Define Ventilator Management Options Start by knowing the four choices you have for reporting ventilator management and the rules governing each. Hospital care: • 94002 -- Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day • 94003 -- ... hospital inpatient/observation, each subsequent day. Long-term care: Important: There is no specific time requirement the pulmonologist must meet to report 94002-94004; however, the physician should still note in the patient's chart the time he spent providing the service, notes Becky Zellmer, CPC, MBS, CBCS, medical billing and coding supervisor for SVA Healthcare in Milwaukee. Weigh Choice Between Ventilator Management and Hospital Care You cannot report ventilator management codes in conjunction with any E/M code (99201-99499) on the same day. So it pays to know which code achieves maximum potential reimbursement when your pulmonologist performs both ventilator management and E/M services on the same day. Example: According to the 2009 Medicare Physician Fee Schedule, 99223 is reimbursed at $180.33, a payment which better reflects the encounter's complexity. The initial day of vent management (94002) earns the provider only $87.64. Caveat: Using the ventilator management code for subsequent care (94003), however, can pay off when a ventilated patient has stable or resolving medical conditions. It may be more advantageous to bill ventilator management in a patient who would otherwise just require the lowest-level hospital follow-up code, says White. Example: How to decide: Don't Pass Up Critical Care Reimbursement Missing an opportunity to report critical care services can mean your practice misses out on well-deserved earnings. When a patient suffers, for instance, from hemoptysis (786.3), severe sepsis (995.92), or shock (639.5), and requires critical care to manage the critical illness or injury in addition to ventilator management, report one of the following critical care codes (as long as the documentation demonstrates the critical condition and all coding requirements are met): • 99291 -- Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes, or • +99292 -- ... each additional 30 minutes (List separately in addition to code for primary service).These codes reflect the provision of complex services and, as a result, are reimbursed at higher levels than either E/M codes or ventilator management codes, relates White. It breaks down like this: • 99291 (initial 30-74 minutes of critical care) earns $212.07, • +99292 (each additional 30 minutes of critical care) is reimbursed at $106.04, while • an initial day of ventilator management (94002) earns only $87.64. Resource: