Pulmonology Coding Alert

Question: Our pulmonologist recently performed ventilator management services and provided extracorporeal membrane oxygenation (ECMO) to a new born infant suffering from acute respiratory distress and diagnosed with congenital diaphragmatic hernia. Can you tell me how I should report the services provided by our pulmonologist?

California Subscriber

Answer: Since congenital diaphragmatic hernia is a life threatening condition, any services provided should be reported using critical care codes. So, you will report 99468 (Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or younger) for all related care.

However, you should also report 33960 (Prolonged extracorporeal circulation for cardiopulmonary insufficiency; initial day) for the ECMO provided by your pulmonologist on the first day and 33961 (Prolonged extracorporeal circulation for cardiopulmonary insufficiency; each subsequent day) for subsequent days of oxygenation provided by your pulmonologist.

Append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other Service) to 99468 to show that the services were distinctive.

Remember: Ensure that you are also including the diagnosis code such as 756.6 (Congenital anomalies of diaphragm) and 518.81 (Acute respiratory failure) to document the medical necessity of the procedure that your pulmonologist performed.