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tci E/M Coding Alert - 2019 Issue 5

Reader Question: Bundle Vent Management in This Critical Care Scenario

Question: Our physician performed vent management on a critically ill patient. We reported 94002 and it was denied. Should we appeal? Arkansas 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. 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 the high complexity multi-faceted evaluation and patient management that is being provided...

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