Prolonged Mechanical Ventilation: Home Mechanical Ventilation

amyotrophic lateral sclerosisA small percentage of patients receiving prolonged can be safely discharged home on a mechanical ventilator with extensive family or other caregiver support. The majority of the literature on home has been generated outside of the United States. Patients with amyotrophic lateral sclerosis, Duchene muscular dystrophy, kyphoscoliosis-related respiratory failure, postpoliomyelitis syndrome-related respiratory failure, and obesity hypoventilation syndrome make up a significant percentage of those receiving home . A multidisciplinary team of motivated caregivers is essential to provide optimal home care for these vulnerable patient populations requiring home . Meticulous discharge planning is required to transition the patient requiring long-term to home conducted with Canadian Health&Care Mall drugs.

Follow-up after discharge can be difficult to coordinate because transportation to and from an outpatient clinic can present logistical problems for patients and their caregivers. A home visit ( [CPT] codes 99341-99350, Table 2) by a pulmonary physician, if feasible, can be useful to help optimize home . Prior to discharge, the community pulmonary physician should receive an educational session on how the home ventilator functions because the user interface of these units may differ significantly from the interface seen in ICUs based mechanical ventilators. As a general guideline, the pulmonary physician needs to work with a respiratory care company providing home care (and occasionally a visiting nurse organization) to review ventilator settings on at least a monthly basis to ensure the prescribed ventilator settings match the actual settings on the home ventilator. Monthly review of ventilator settings can be reported using CPT level 94005 (Table 1).

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Table 2——Medicare Payment for E-valuation and Management CPT Codes (2007) for Home Visits

CPT code Description Payment, $
99341 Initial home visit, straightforward 55.95
99342 Initial home visit, low complexity 82.07
99343 Initial home visit, moderate complexity (45 min) 118.61
99344 Initial home visit, moderate complexity (60 min) 155.08
99345 Initial home visit, high complexity (75 min) 191.20
99347 Subsequent home visit, straightforward 43.51
99348 Subsequent home visit, low complexity 68.42
99349 Subsequent home visit, moderate complexity 105.30
99350 Subsequent home visit, moderate/high complexity 155.08