Pulmonology Coding Alert

Question: Our pulmonologist is frequently asked to see patients who have been placed on ventilators after back surgery. We report 94656 (Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; first day) for the initial visit and 94657 ( subsequent days) for any subsequent visits. Which diagnosis code should we use for post-back-surgery ventilator management? New Jersey Subscriber Answer: Patients are not routinely placed on mechanical ventilation after back surgery. Most pulmonologists initiate ventilator management only if the patient has a respiratory complication. If the pulmonologist initiates pressure or volume preset ventilation for assisted or controlled breathing, he or she may report 94656. If another physician initiates ventilation on a previous day, the pulmonologist can report only 94657. As the primary diagnosis for these procedure codes, you should use the patient's respiratory condition that required the ventilator's use. The patient's post-back-surgery status (V45.89) may be listed as a secondary condition. Such patients will likely not require intubation and ventilation, but some respiratory condition is almost always present. Because the E/M codes reimburse at a higher rate, consider reporting a consultation (99241-99245) or other E/M service instead of the ventilator management. In addition, you should remember that the Correct Coding Initiative bundles ventilator management into the E/M codes.