Wiki Vent management vs. critical care

[krisfelty]

I have a question, we have some Pulmonologists that see critically ill patients in the intensive care and bill the appropriate codes 99291-99292. Now, a carrier is downcoding these visits to vent management codes 94003?? There is a complete note with physical exam, MDM , etc....Does anyone know anything about this and if they can do this??
Thanks!

 

[jettman]

I have a question, we have some Pulmonologists that see critically ill patients in the intensive care and bill the appropriate codes 99291-99292. Now, a carrier is downcoding these visits to vent management codes 94003?? There is a complete note with physical exam, MDM , etc....Does anyone know anything about this and if they can do this??
Thanks!

First and foremost, are the patients on vents? If not, the carrier doesn't have a leg to stand on.

If your pulmonologists are providing and documenting medically necessary critical care and the patient is on a vent, vent management is included in the critical care codes, so the CC codes are the most appropriate, as supported.

Personally I would make a hasty phone to the carrier and ask them what gives.

Best of Luck!