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Wiki Pulmonary Trach Decannulation

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janellglascock@gmail.com

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Our current trach decannulation protocol includes a nap study (95808) followed by an overnight sleep study (95782). Since there is an NCCI edit and we are not getting reimbursed for the nap polysomnogram, we have to find other ways to safely decannulate these patients.
We are proposing to decanulate on the floor.
The patient will come directly to our floor as observation (99220),
an attending physician will decannulate the stoma on the floor and directly monitor the patient for 1 hr.

We have two questions:

  1. Can we bill critical care time for this 1 hr of direct monitoring? (the child may decompensate and the trach may have to be replaced)

  1. If the patient does not tolerate the decannulation and the trach is placed back, the child will be discharged to home. So – in this case – the patient will be on the floor for several hours only. How can we bill for this overall encounter?
 
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