Anesthesia Coding Alert

Question: What is the best way to code for a patient with long-term ICU or CCU care, such as ventilator management? Should we code for each day individually, or code the care weekly?

Vermont Subscriber  
Answer: You should code each day separately because the supporting diagnoses may vary from day to day. The appropriate CPT codes can also change from one day to the next, depending on the amount of time spent with the patient and his or her overall condition. If the level and complexity of care change a lot, it may be better to use a critical-care code (99291, critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes; or 99292, ... each additional 30 minutes) instead of a subsequent-day ventilator code (94657, ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; subsequent days).
 
For example, if a patient on long-term care aspirates after one week and the anesthesiologist spends 45 minutes reviewing and adjusting the patients ventilator and optimizing hemodynamics, critical-care E/M code 99291 should be billed because the level of work and care justifies the higher reimbursement seen with this code.
 
Note: For more information on billing for ventilator management, see the August 2001 issue of Anesthesia and Pain Management Coding Alert.