First and foremost, what is Mechanical Ventilation?
Mechanical ventilation is a process by which gases are moved into the lungs by means of a mechanical device that assists respiration by augmenting or replacing the patient’s own ventilatory effort. With mechanical ventilation, the patient is either intubated or receives a tracheostomy and a variable degree of assistance is delivered to meet respiratory requirements in an uninterrupted fashion.
What root operations are applicable to Mechanical Ventilation?
- “Performance”: This root operation is for invasive mechanical ventilation (completely taking over a physiological function by extracorporeal means)
- “Assistance”: This root operation is for noninvasive mechanical ventilation (taking over a portion of a physiological function by extracorporeal means)
What determines Invasive vs. Noninvasive Mechanical Ventilation?
Per the Coding Clinic 4th Quarter 2014, Page 3, the following applies for Invasive Mechanical Ventilation:
When assigning codes for mechanical ventilation, the coder should review the health record to determine if the patient was:
- On mechanical ventilation for less than 24 consecutive hours (code 5A1935Z)
- 24-96 consecutive hours (code 5A1945Z)
- Or greater than 96 consecutive hours (code 5A1955Z)
These codes would not be reported to capture mechanical ventilation that is being used during a surgical procedure. The ventilatory support that is provided to a patient during surgery is considered an integral part of the surgical procedure and is not coded separately.
For noninvasive mechanical ventilation BiPAP, the patient is not intubated will be coded to root operation “Assistance.” BiPAP that is being delivered to the patient through an endotracheal tube or a tracheostomy will be coded as mechanical ventilation with the root operation “Performance.”
What are the guidelines around starting duration count for mechanical ventilation?
Page 3 of the Coding Clinic 4th Quarter 2014 addresses this question as well. Start counting the duration of mechanical ventilation with one of the following:
- Endotracheal intubation (and subsequent initiation of mechanical ventilation),
- Initiation of mechanical ventilation through a tracheostomy, or
- At the time of admission of a previously intubated patient or a patient with a tracheostomy who is on mechanical ventilation
Answering Complicated Questions for Coders
Further review of the Coding Clinic 4th Quarter 2014: Page:3 on Mechanical Ventilation can help coders answer complicated questions regarding code assignment for both invasive and noninvasive mechanical ventilation.
Question: How are the hours counted for a patient on mechanical ventilation only at night?
Answer: If the patient is on mechanical ventilation only at night (e.g. for treatment of sleep apnea), and the patient is not being weaned, count the duration that the patient was actually put on the ventilator. For each overnight use, assign code 5A1935Z, Respiratory ventilation, less than 24 consecutive hours. For patients being weaned from intermittent (nocturnal) ventilation, calculate the entire weaning trial, including the time the patient is on the ventilator, the weaning period up until the patient is extubated, and the ventilator is turned off.