Previously published Coding Clinic advice regarding the counting of mechanical ventilation hours for patients admitted for weaning assumed that the patient was already on mechanical ventilation at the time of admission. However, our question relates to patients admitted to a long term care hospital on a T-piece or tracheostomy collar the day of the transfer, but placed on mechanical ventilation that evening. How are the hours of mechanical ventilation counted? Should we begin counting hours at the start of the admission even though the patient is breathing through the T-piece without mechanical ventilation, or are the hours counted from the time the patient is on the vent?
Yes, you should begin counting hours at the start of the admission. All of the period of weaning is counted during the process of withdrawing the patient from ventilatory support. The duration includes the time the patient is on the ventilator, the weaning period and ends when the mechanical ventilation is turned off (after the weaning period). The fact that a T-piece is being used during the day does not affect code assignment. A T-piece (trach-collar) trial involves the patient breathing through a T-piece without ventilatory assistance for a set period of time.