Pulmonology Coding Alert

Question: Our pulmonologist performed vent management on a critically ill patient. We reported 94002 and it was denied. Should we appeal?

Arkansas Subscriber

Answer: If your physician provides initial-day ventilation management services in the course of treating a critically ill or injured patient, you’ll report the critical care code instead of a ventilation management code, per CPT^® guidelines, as long as the 30-minute threshold for critical care has been met.

The reason: Ventilation management, when performed, is specifically bundled into the critical care code (and most other E/M codes); these E/M codes are a more accurate representation of the high complexity multi-faceted evaluation and patient management that is being provided.

“It should be noted that code 94002 [Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day] may not be reported in conjunction with evaluation and management services 99201-99499,” according to the March 2007 CPT^® Assistant. The 2021 CPT^® parenthetical which follows the code descriptor also backs this up: “Do not report 94002-94004 in conjunction with E/M services 99202-99499.”

If the notes indicate that the physician provided ventilation management in the course of a greater E/M service, you’ll want to be sure to bundle all of the encounter work and choose the proper E/M code.

Here’s why: With few exceptions, the physician will provide a high-level inpatient E/M service (such as 99223 (Initial hospital care, per day, for the evaluation and management of a patient …)), which is a more appropriate representation of the additional cognitive work being performed beyond simply managing the ventilator settings.