Coding Ventilator Management Outside Global Anesthesia Services
Published on Wed Aug 01, 2001
Beginning in 2001, CMS (formerly HCFA) bundled ventilation-management (VM) codes with inpatient-care codes, which means Medicare carriers no longer view VM as a distinct service. It is considered part of the anesthesia service if it is performed as maintenance during a patient's surgical procedure. But there are circumstances outside the original procedure that allow billing it separately.
Ins and Outs of Ventilation-Management Codes
Two CPT codes apply to VM: 94656 (ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; first day) and 94657 (... subsequent days). An important point to keep in mind is that 94656 is for the initial placement of the vent, and not necessarily the first day a physician sees the patient.
"Some doctors attempt to bill 94656 when they see the patient for the first time, and they didn't place the patient on the ventilator originally," says Cecelia McWhorter, BA, CPC, a coder with the physician billing agency Comp One Services Ltd. in Oklahoma City. "The code is intended for the first day of vent management, period -- not a physician's first visit with the patient."
For example, an anesthesiologist places a patient on VM, a service coded as 94656. When he or she checks on the patient's status the next day, code that visit with 94657. Scott Groudine, MD, an Albany, N.Y., anesthesiologist, says the physician's notes and corresponding codes in this case might read:
June 12:
Called to intubate Mrs. Smith, who has just had a major myocardial infarction -- 31500 (intubation, endotracheal, emergency procedure).
A-line placed -- 36620 (arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure];percutaneous).
Ventilator management for first day -- 94656; critical care provided by cardiologist.
June 13:
Ventilator adjusted; started weaning patient -- 94657.
June 14:
Patient weaned off ventilator -- 94657.
Vent Management Separate from E/M
Many carriers, such as Louisiana Medicare, have policies that state, "Payment for ventilation and management, CPT codes 94656 and 94657, includes evaluation and management service by the same physician on the same date. Visits on the same date are bundled into reimbursement for the ventilation-management service."
The exception is if the E/M service can be documented as significant and separately identifiable. For example, an anesthesia provider is called to assess a case of respiratory distress and treats the patient with inhalers and other respiratory therapy. Several hours later the respiratory distress worsens, and the provider intubates the patient and begins vent management. The patient is then transferred to ICU, where the [...]
