|
36.4.51 Ventilation Assist and Management for the Inpatient
Use the following procedure codes and guidelines for reimbursement of ventilation assist and management: 1-94002 and 1-94003. Procedure codes 1-94002 and 1-94003 apply to hospital care only. Respiratory care billed in any other POS will be denied.
Use the ventilation assist and management subsequent code (1-94003) when respiratory support must be established for a patient in the postoperative period in the hospital (POS 3). Subsequent days of ventilation assistance are payable when documentation indicates a respiratory problem.
When the use of a ventilator is required as part of a major surgery, initial ventilation assist and management will be denied. It should be billed as ventilation assist and management subsequent code 1-94003.
Procedure codes 1-94002 and 1-94003 apply only to hospital care for critically ill patients. They do not apply to routine recovery room ventilation services. Separate support service charges billed on the same day as ventilatory support are denied (for example, initiation or maintenance of intravenous therapy or infusions, total parenteral nutrition (TPN)/hyperalimentation; arterial or venous punctures; interpretations of arterial blood gases; pulmonary function tests and management of the hemodynamic functions of the patient; intensive care visits; subsequent hospital visits; or any other hospital visit).
Use ventilation assist and management and initiation of pressure or volume preset ventilators for assisted or controlled breathing-first day (1-94002) when respiratory support must be established for a patient. It is a one-time charge per hospitalization that may be paid when the claim documents that a respiratory problem exists (for example, respiratory distress, asphyxia). After the first day, use subsequent days (1-94003).
Ventilation assist and management procedures 1-94002 and 1-94003 are not payable when billed by the same provider on the same date of service as the procedure codes listed below:
Procedure code 1-94003 will be denied when billed for the same date of service as 1-94002.
|
