Pulmonology Coding Alert

Question: A pulmonologist visits a patient with acute respiratory failure in the medical intensive care unit (MICU). During the visit, the physician initiates and adjusts mechanical ventilation for the patient. Should I report 94656, or an appropriate hospital care code (99221-99223)?


Massachusetts Subscriber
Answer: First, remember that you can never bill ventilator management in addition to an E/M code. You have to choose between billing for the E/M service or ventilator management. Your decision should depend on the extent of the pulmonologist's activities during the visit and the available documentation. If he simply initiates ventilation and notes this activity, you should report only 94002 (Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day). But if the physician performs and documents the key components of history, examination and decision-making, instead report the appropriate level of hospital care (99221-99223, Initial hospital care for the evaluation and management of a patient). Remember: A patient is eligible for only one initial hospital care service per hospitalization, and the admitting physician/group should bill this service. If the pulmonologist sees the patient for the first time during the course of the hospitalization and is not the admitting physician, he must choose between ventilation management and either a consultation (99251-99255) or subsequent hospital care (99231-99233).