tci E/M Coding Alert - 2021 Issue Q2

You Be the Coder: Look to Critical Care Code in This Vent Situation

Question: Our pulmonologist performed vent management on a critically ill patient. We reported 94002 and it was denied. Should we appeal? Kansas Subscriber Answer: If your physician provides initial-day ventilation management services in the course of treating a critically ill or injured patient, you’ll report the critical care code instead of a ventilation management code, per CPT® guidelines, as long as the 30-minute threshold for critical care has been met. The reason: Ventilation management, when performed, is specifically bundled into the critical care code (and most other E/M codes); these E/M codes are a more accurate representation of...

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