Professional Reimbursement in Prolonged Mechanical Ventilation Explained by Canadian Health&Care Mall

ICUThe American Medical Association has published new and revised ventilator management codes for 2007 that were implemented on January 1, 2007 (Table 1). This article addresses clinical and billing issues pertinent to this topic.

The numbers of patients requiring prolonged mechanical ventilation appears to be increasing. This trend likely reflects improved ICU survival, a trend toward earlier tracheostomy, and pressure to reduce length of stay at some acute care facilities. Current data indicate that 5 to 20% of subjects receiving mechanical ventilation in the ICU will require prolonged mechanical ventilation carried out with preparations of Canadian Health&Care Mall healthcaremall4you.

Prolonged Mechanical Ventilation

A recent consensus conference has recommended that prolonged mechanical ventilation be defined as the need for continual assistance from a mechanical ventilator for at least 6 h/d for at least 21 days. As yet, this consensus definition has not been uniformly accepted or implemented but appears to be a useful way of defining prolonged mechanical ventilation. Patients who require prolonged mechanical ventilation usually have a tracheostomy tube placed when they are still in the ICU. Epidemiologic data indicate that the number of patients undergoing tracheostomy for prolonged mechanical ventilation is increasing. Outcome data indicate a trend toward earlier placement of a tracheostomy tube in the course of critical illness. Patients who require prolonged mechanical ventilation via tracheostomy are considered chronically critically ill. The exact point in time when the transition from acute to chronic critical illness occurs has been difficult to determine. Any definition would need to encompass time dependent on mechanical ventilation, time of onset of hemodynamic and pulmonary stability, and the availability of a bed outside of the ICU setting to care for the patient.

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Table 1—Medicare Payments for Ventilator Management Codes Effective for Services on or After January 1, 2007

Code Description Payment, $f
94002 Ventilation assist and management, initiation of pressure or volume mechanical ventilation for assisted or controlled breathing; hospital, inpatient/observation, initial day 85.31
94003 Ventilation assist and management, hospital, inpatient/observation, each subsequent day 62.60
94004 Ventilation assist and management, nursing facility, per day 45.62
94005 Home ventilator management care plan oversight of a patient (patient not present) in home, domiciliary or rest home (eg, assisted living) requiring review of status, review of laboratories and other studies and revision of orders and respiratory care plan (as appropriate), within a calendar month, > 30 min 82.26
94660 Continuous positive airway pressure ventilation, initiation and management (facility) 36.39
94662 Continuous negative pressure ventilation, initiation and management 36.08