ED Coding and Reimbursement Alert

Question: A patient with a diagnosis of sleep apnea reported to the ED. In the midst of performing a level-three observation service, the patient suffered acute respiratory failure and the physician stabilized him with continuous positive airway ventilation (CPAP). Can we report two codes -- one for the observation and one for the CPAP?


Ohio Subscriber


Answer: In this instance, you cannot report the CPAP and the observation. According to the National Correct Coding Initiative (NCCI), CPAP is considered a component of the observation codes, and therefore not separately codable.

On the claim,

- report 99236 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision-making of high complexity) for the encounter.

- attach 518.81 (Acute respiratory failure) to 99236 to account for the patient's respiratory failure.

- attach 780.57 (Unspecified sleep apnea)  to 99236 to represent the patient's sleep apnea.

The NCCI also bundles the following services into most E/M codes from the observation and emergency department code sets:

- 90862 -- Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy

- 94660  -- Continuous positive airway pressure ventilation (CPAP) initiation and management.