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Vent management vs. critical care

  1. #1
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    Phoenix/Scottsdale
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    139
    Default Vent management vs. critical care
    Medical Coding Books
    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!

  2. #2
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    Quote Originally Posted by kfelty View Post
    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!
    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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