Ventilation Management Shouldnt Cause Coding Failure
Published on Tue Apr 01, 2003
You need to put your ventilation management know-how to the test so you can make all A's next time you bill for services provided to your respiratory failure patients.
Patients with respiratory failure often need mechanical ventilation to support their breathing. Patients may be admitted directly to the medical intensive care unit (MICU) or be moved from another floor within the hospital. The pulmonologist may need to provide critical care services to a patient in respiratory failure or simply administer ventilation. Sometimes he performs services other than ventilation management that could qualify you to bill for an E/M visit.
These scenarios bring up interesting coding questions. Test yourself with the following questions so see how you fare when it comes to coding properly for respiratory failure patients. Question 1: What is the proper diagnosis code for respiratory failure?
There are three codes for respiratory failure. Code 518.81 represents acute respiratory failure, 518.83 represents chronic respiratory failure, and 518.84 represents acute on chronic respiratory failure. Picking the proper diagnosis code can be tricky, since physicians often use the term "respiratory failure" as a "catchall" phrase when a patient cannot breathe well, says Charlie Strange, MD, FCCP, director of the medical intensive care unit at the Medical University of South Carolina in Charleston. The difference between the two types is somewhat arbitrary and determined by how completely the patient normalizes his lung function between episodes of the disease, he says.
Consider a patient with end-stage emphysema who has consistently altered carbon dioxide and oxygen levels. The patient is oxygen-dependent with a diagnosis of chronic respiratory failure (518.83). He presents in the emergency department for an exacerbation of emphysema, which severely deteriorates the patient's already compromised condition, causing acute respiratory failure. In this case, you would report 518.84 for acute on chronic respiratory failure. Strange says that you can code some causes of respiratory failure by the underlying cause of the problem, such as pneumonia (486). You can provide more than one diagnosis code to accurately reflect the patient's illness and co-existing conditions. In the scenario above, you could use 518.84 in conjunction with 492.8 (Other emphysema). This could help establish medical necessity to the payer. Question 2: What procedures constitute mechanical ventilation?
There are invasive and noninvasive ways to ventilate patients, Strange says. The invasive technique involves placement of an endotracheal tube with any of 20 different modalities of mechanical ventilation (ventilation machine) or the placement of a tracheostomy to hook to the mechanical ventilation. The physician often performs the latter when there is the possibility of extended chronic ventilation.
Strange adds that the noninvasive ventilatory strategies include ventilation with a mask over the nose or mouth that the pulmonologist hooks to a machine that [...]
