Trach and ventilation (long)

Patient comes in with previous trach and receives O2 via trach collar. Never attached to the vent, never receives BiPAP or CPAP. Stays longer than 96 hours.

Would you code this as:
96.72, mechanical ventilation > 96 hours, or
93.90, noninvasive mechanical ventilation.

Coding clinics say:

4Q2008: The code title for code 93.90 has been revised to "Noninvasive mechanical ventilation." Mechanical ventilation is classified as noninvasive (93.90) when delivered via a noninvasive interface like a face mask, nasal mask, nasal pillow, oral mouthpiece or oronasal mask, or without an endotracheal tube or tracheostomy. Types of respiratory assistance considered noninvasive mechanical ventilation include continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), noninvasive positive pressure ventilation (NIPPV), nonpositive pressure ventilation (NPPV), and mechanical ventilation not otherwise specified...The code titles for category 96.7 and codes listed under this category have been revised to clarify that these codes are for continuous invasive mechanical ventilation. Inclusion terms have been added to indicate that this subcategory is for mechanical ventilation delivered through an invasive interface.

4Q2014: [trach mask question] Oxygen delivered via a tracheal mask is not mechanical ventilation. It is a method to provide supplemental oxygen. A tracheostomy tube (T-tube) fits inside the stoma and is secured by a harness to the neck. The T-tube may be used by some patients in need of oxygen therapy. Oxygen can be delivered directly through the tracheostomy via a T-tube or a tracheal mask placed directly to the stoma. Mechanical ventilation delivered via a tracheal tube directly into the stoma would be coded as mechanical ventilation.

Appreciate any insights.

Renee

Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
Director, Clinical Documentation, Core Measures and Outcomes
Tanner Health System

Comments

  • No, only supplemental 02. No vent

    Juli

  • Hi,

    It seem like there is no mechanical ventilation?? am I missing something?


  • No, there is no mechanical vent. Coding is citing the 4Q2008 CC as evidence of mechanical ventilation, taking it to 96.72, and I strongly disagree. But I need something I can hang my hat on in my discussion with them. I tried to locate some evidence of RAC or OIG findings but can't find any cases on point.

    Thanks,

    Renee

    Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
    Director, Clinical Documentation, Core Measures and Outcomes
    Tanner Health System
  • AHA CC 1Q 2008 pg 9: BiPAP via trach is still 'assistance' (pt has ability to breath on their own), not 'performance' as a mechanical vent would be (pt does not breath on their own).
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