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Wiki Vent management vs. critical care

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krisfelty

krisfelty

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I have a question, we have some Pulmonologists that see critically ill patients in the intensive care and bill the appropriate codes 99291-99292. Now, a carrier is downcoding these visits to vent management codes 94003?? There is a complete note with physical exam, MDM , etc....Does anyone know anything about this and if they can do this??
Thanks!
 
kfelty said:
I have a question, we have some Pulmonologists that see critically ill patients in the intensive care and bill the appropriate codes 99291-99292. Now, a carrier is downcoding these visits to vent management codes 94003?? There is a complete note with physical exam, MDM , etc....Does anyone know anything about this and if they can do this??
Thanks!
Click to expand...

First and foremost, are the patients on vents? If not, the carrier doesn't have a leg to stand on.

If your pulmonologists are providing and documenting medically necessary critical care and the patient is on a vent, vent management is included in the critical care codes, so the CC codes are the most appropriate, as supported.

Personally I would make a hasty phone to the carrier and ask them what gives.

Best of Luck!
 
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