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94002 billing for transfer patient

Abdul Posted Wed 15th of April, 2020 10:20:04 AM
hi Dear, I am from a payer side. I have one question, if a patient is already intubated and on ventilatory support is being transferred from facility A to facility B for further management. can the receiving facility B bill 94002 code? if they continue the ventilation management without interruption or the facility B should code 94003 instead. the reason I am asking as, 94002 increases the weight of DRG which increases the payment. we have already paid the ventilation setting charges billed under 94002 to facility A and after transfer of patient to facility B , we have to pay again for 94002 which has huge financial impact. kindly clarify the above concern and provide a reference if possible. thank you so much . Dr.Rauf
SuperCoder Answered Thu 16th of April, 2020 08:22:40 AM

Hi,

 

Thanks for your question.

 

The answer to this question is that the receiving facility B can bill CPT code 94002 (Ventilation assist and management …. initial day) for the first date of service and then 94003 (Ventilation assist and management …. each subsequent day) for next day onwards.

 

But remember, if a physician provides initial-day ventilation management services (e.g. CPT code 94002) in the course of treating a critically ill or injured patient, a coder should report the critical care code instead of a ventilation management code (94002 or 94003). When an emergency physician provides ventilation management, it is usually for a patient requiring high-level ED E/M service, subsequent hospital care, or typically in most cases, even critical care. 

 

Please feel free to write if you have any question.

 

Thanks.

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