Mary ann Posted Wed 13th of November, 2013 09:35:13 AM
The patient is ac/chronic respiratory failure with an existing trach. She is on nocturnal ventilator at home which was continued in the hospital. Her length of stay was 5 days. Would I code the vent daily since it is applied daily? Or do I add it up for >96 hrs ventilation? There is a recent CC on nocturnal ventilation but it is talking about weaning a patient. How would I code this? Thanks
SuperCoder Answered Thu 14th of November, 2013 01:39:01 AM
Report 94002 (Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day) for ventilator management. Report the patient's condition by appending 518.81 (Acute respiratory failure) to 94002.
If your pulmonologist treats a patient exclusively for ventilator management, you'll choose from 94002, 94003, or 94004 (... nursing facility, per day) depending on the location of the service and the day of treatment.
Important: Code 94002 includes the pulmonologist providing the service, reviewing the patient's chart, seeing the patient, writing notes and communicating with other healthcare professionals and the patient's family/caregiver.
Mary ann Posted Thu 14th of November, 2013 14:04:12 PM
My question is related to counting vent hours for ICD-9-CM procedure code 96.71, 96.72....not on CPT codes. Thanks
SuperCoder Answered Fri 15th of November, 2013 09:21:16 AM
Documentation Necessary for Code Assignment
It is critical that coders base code assignment on documentation of the dates and times that mechanical ventilation was started and ended. This documentation should be found in the medical record whenever intubation or extubation occurs. If the coder is unable to locate this necessary documentation, then management should take appropriate action to ensure that this documentation is contained within the medical record and is accessible to the coders.
Count the Number of Hours, Not Days
ICD-9-CM code 96.71 is reported when the duration of mechanical ventilation is less than 96 consecutive hours. ICD-9-CM code 96.72 is reported when the duration of mechanical ventilation is 96 consecutive hours or more. Yes, 96 hours equals 4 days. No, coders cannot look solely at the number of days when determining whether to report code 96.71 or 96.72. It is critical that the code assignment be based on the precise number of hours of continuous mechanical ventilation. It is an area of much focus and attention in coding audits.
For example, a patient was intubated and placed on continuous mechanical ventilation on December 1 and extubated on December 5. Is there sufficient information to determine whether code 96.71 or 96.72 should be reported? The answer is no. It is not known if the patient was on mechanical ventilation for less than 96 hours or if the patient was on mechanical ventilation for 96 hours or more.
What if this patient was intubated and placed on continuous mechanical ventilation on December 1 at 23:59 hours and was extubated December 5 at 09:23 hours? Is there sufficient information to determine whether code 96.71 or 96.72 should be reported? The answer is yes. This patient was on continuous mechanical ventilation for 81 hours and 24 minutes. ICD-9-CM code 96.71, Continuous invasive mechanical ventilation for less than 96 consecutive hours, would be reported.
Follow the Instructional Note Under Subcategory 96.7
In the ICD-9-CM procedure code set, the following note appears under ICD-9-CM subcategory 96.7, Other continuous invasive mechanical ventilation:
To calculate the number of hours (duration) of continuous mechanical ventilation during a hospitalization, begin the count from the start of the (endotracheal) intubation. The duration ends with (endotracheal) extubation. If a patient is intubated prior to admission, begin counting the duration from the time of the admission. If a patient is transferred (discharged) while intubated, the duration would end at the time of transfer (discharge). For patients who begin on (endotracheal) intubation and subsequently have a tracheostomy performed for mechanical ventilation, the duration begins with the (endotracheal) intubation and ends when the mechanical ventilation is turned off (after the weaning period).
To calculate the number of hours of continuous mechanical ventilation during a hospitalization, begin counting the duration when mechanical ventilation is started. The duration ends when the mechanical ventilator is turned off (after the weaning period). If a patient has received a tracheostomy prior to admission and is on mechanical ventilation at the time of admission, begin counting the duration from the time of admission. If a patient is transferred (discharged) while still on mechanical ventilation via tracheostomy, the duration would end at the time of the transfer (discharge).
Carefully follow all notes found under ICD-9-CM subcategory 96.7.