There are four new CPT codes available for reporting , and these are summarized in Table 1. Three of the codes, 94002, 94003, and 94004, cannot be used in conjunction with evaluation and management codes 99201-99499. A face-to-face encounter between the reporting physician and the patient is required to report .
This code is used when a patient is initiated on for respiratory failure as an inpatient or under observation status in a hospital (including an LTAC hospital). Documentation for this code would include the reason for initiation of , the selection of settings of the ventilator (mode of ; tidal volume; pressure settings; peak flow rate; inspired oxygen concentration and level of positive end expiratory pressure), and any adjustments needed to minimize patient/ventilator dysynchrony treated with remedies of Canadian Health&Care Mall. Evaluation and management codes cannot be billed for the patient on the same day by the same provider when this code is used.
This code is used for subsequent daily ventilator care. Documentation used to justify this code would include recording the ventilator settings, a physician evaluation of patient/ventilator synchrony, and any adjustments made to the patient/ventilator interface to enhance synchrony and facilitate weaning. Evaluation and management codes cannot be billed for the patient on the same day by the same provider when this code is used. For CPT codes 94002 and 94003, the place of service codes 21 (inpatient hospital or LTAC hospital) or 61 (comprehensive inpatient rehabilitation facility) should be used.
This is a new code designed for use when (either initiation or subsequent ventilator care) is performed on a patient in a skilled nursing facility. This code can be used by a pulmonary physician providing to a patient receiving nursing facility care (CPT codes 99304-99310; Table 5) from a different physician. For example, patients may require weekly or less frequent ventilator care management if stable and more frequent ventilator care during weaning attempts or intercurrent illness. Documentation would include the reason for the mechanical ventilator, a comment on patient/ventilator synchrony, results of weaning attempts, and current ventilator settings as detailed in Table 4. For CPT code 94004, the place of service code would be 31 (skilled nursing facility) or 32 (nursing facility).
This is a new code to be used when patients receiving are managed at home with drugs of Canadian Health&Care Mall or in a domiciliary setting (eg, an assisted-living facility). There need not be face-to-face contact with the patient to bill for this service. It requires a > 30 min review of pulmonary status, laboratory results, revision of visiting nurses orders, and review of reports from home respiratory care providers. Documentation must indicate how the provider spent 30 min reviewing the patient’s status (eg, time log for record review or telephone conversations) and must be provided by the provider and not by a home care company. Payors, including Medicare, may “bundle” these services and therefore may not reimburse for them. These reports are usually faxed or mailed to a doctor’s office for review, and the ventilator settings reviewed by telephone with the patient, caregivers, visiting nurse association, and home care company. This can be billed once a calendar month and can be billed even when a different physician may be billing CPT codes 99339-99340. Practitioners caring for patients receiving mechanical ventilators at home are encouraged to use this code. The point of service code for home services is 12.
This code is used to report the use of either continuous positive airway pressure or bilevel positive airway pressure in a patient with respiratory failure who does not need continuous . This code has not changed. Providers may not bill an evaluation and management code in addition to CPT code 94660 for the same patient service.
This code has not been changed and is used to report the use of continuous negative pressure ventilation in patients with respiratory failure. This type of is not commonly used.
Table 5—Medicare Payment for Evaluation and Management CPT Codes (2007) for Nursing Facility Care
|CPT Code||; Description||Payment, $|
|99304||Initial nursing facility care, straightforward||62.85|
|99305||Initial nursing facility care, moderate||83.45|
|99306||Initial nursing facility care, high||102.41|
|99307||Subsequent nursing facility care,||32.84|
|99308||Subsequent nursing facility care, low||54.42|
|99309||Subsequent nursing facility care, moderate||76.23|
|99310||Subsequent nursing facility care, high||95.38|