Pulmonology Coding Alert

Question: Through a recent denial I learned that I cannot report both a ventilation therapy and an E/M code for the same patient on the same day. How do I determine which to report if the pulmonologist provides both services? Tennessee Subscriber Answer: Base your code choice on the encounter notes. 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. Alternatively, if the notes describe an encounter in which the pulmonologist performs ventilation management during the course of a larger E/M, report the E/M code. According to CPT, all of the ventilation therapy codes (94002-94004, 94660, 94662) are bundled into E/M codes, meaning you cannot report ventilation therapy with an E/M service. Critical care codes (99291-+99292) may be most appropriate for a patient with acute respiratory failure in which the physician manages the respiratory [...]