Pulmonology Coding Alert

Question: I have a pulmonologist’s report that states they performed ventilation assist and management for a patient at a local hospital. The patient was admitted on a Sunday and received ventilation through Friday of the same week.

How do I report the ventilator management services?

Washington Subscriber

Answer: The CPT^® code set lists four ventilator management codes under the Pulmonary code section:

• 94002 (Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day)
• 94003 (… hospital inpatient/observation, each subsequent day)
• 94004 (… nursing facility, per day)
• 94005 (Home ventilator management care plan oversight of a patient (patient not present) in home, domiciliary or rest home (eg, assisted living) requiring review of status, review of laboratories and other studies and revision of orders and respiratory care plan (as appropriate), within a calendar month, 30 minutes or more)

For your report, you can immediately eliminate 94005 from the coding options since this code is strictly for home ventilator management. Next, you’ll cross out 94004 since you indicated the pulmonologist performed the services in the hospital.

This leaves 94002 and 94003 for your coding options. You’ll assign 94002 for Sunday’s services if the pulmonologist initiated vent management, and then you’ll need five units of 94003 to report the services on Monday through Friday. If the pulmonologist takes over the care from another pulmonologist who initiated vent management, report 94003 Sunday through Friday.

In summary, your CPT^® codes will be: 94002, 94003 x 5.