Pulmonology Coding Alert

Patient's status, therapy type lock down pay You can avoid losing over $100 for reporting ventilation therapy when your pulmonologist performed critical care, if you focus on the encounter notes. But when documentation supports only the ventilation management, you must choose a procedure code rather than the E/M, or you'll be overcoding the claim. Let our experts show you which details to zoom in on for the most ethical and optimal ventilation management claims. Choose Vent Therapy or E/M -- Not Both According to CPT, all of the ventilation therapy codes mentioned in this article (94002-94004, 94660, 94662) are bundled into E/M codes, meaning you cannot report ventilation therapy with an E/M service. When your pulmonologist performs 94002-94004, 94660 or 94662, you'll need to decide whether to report the ventilation therapy or roll the work into the E/M level, says Kent Moore, a healthcare financing and delivery systems manager in Leawood, Kan. Notes for encounters in which the pulmonologist provides ventilation management will likely lead you to the proper code choice; if the pulmonologist focuses on ventilation management services during the encounter and does not document key components warranting an E/M, report a ventilation management code. But if the notes describe an encounter in which the physician performs ventilation management during the course of a larger E/M, report the E/M code. "So if an E/M service code, such as subsequent hospital care or initial hospital care, more accurately describes the service provided by the physician, you should report that code instead," Moore says. Also, critical care codes may be more appropriate for the patient with acute respiratory failure in which the physician manages the respiratory failure as well as the underlying or related conditions. Benefit: Choosing to report the E/M instead of ventilation management, when allowable, may benefit the practice's bottom line. The E/M codes typically associated with ventilation management codes (critical care, inpatient hospital care) require much more work and documentation, and they pay at a higher rate than the ventilation management codes. "In most cases, if you did enough work to qualify for an E/M level, you would want to report the E/M," says Denae Merrill, CPC, coder for Covenant MSO in Saginaw, Mich. Example: If you choose to report 94003 (Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, each subsequent day), but your physician provides services more in line with 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes), you'll miss out on deserved reimbursement. The physician work relative value units (RVUs) for 94003 are 1.37, while the RVUs for 99291 are 4.50. So the reimbursement for 94003 is about [...]