How To Use CPT Code 94004

CPT 94004 describes the daily management of ventilator assistance for patients in long-term care facilities. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 94004?

CPT 94004 can be used to report the daily management of ventilator assistance for patients in long-term care facilities. This code is used when a provider delivers ongoing care and support to a patient who requires mechanical ventilation. The provider adjusts the ventilator settings and monitors the patient’s response to treatment.

2. Official Description

The official description of CPT code 94004 is: ‘Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; nursing facility, per day.’

3. Procedure

1. The provider assesses the patient’s respiratory condition and determines the need for ventilator assistance.
2. A pressure or volume preset ventilator is initiated to support the patient’s breathing.
3. The provider monitors the patient’s response to the ventilator and adjusts the settings as necessary.
4. The provider documents the duration of treatment, the patient’s diagnoses or reasons for ventilation, and the patient’s response to treatment.
5. The provider gradually reduces ventilatory support to facilitate weaning, allowing the patient to breathe on their own.
6. The provider continues to monitor the patient’s progress and adjusts the ventilator settings accordingly.

4. Qualifying circumstances

CPT 94004 is used for patients in long-term care facilities who require ventilator assistance. These patients have respiratory conditions that necessitate mechanical ventilation. The provider must have a face-to-face encounter with the patient to report ventilator management. Medicare does not specify a time requirement for this encounter, but the provider should document the time spent providing the service.

5. When to use CPT code 94004

CPT code 94004 should be used when a provider delivers daily management of ventilator assistance for a patient in a long-term care facility. This code should not be reported in conjunction with evaluation and management services. If the provider’s notes primarily focus on ventilation management without documenting key components warranting an E/M service, report CPT 94004. If the notes describe an encounter where the provider performs ventilation management along with care for the patient’s other problems, report the appropriate E/M code if supported by documentation.

6. Documentation requirements

To support a claim for CPT 94004, the provider must document the following information:

• Face-to-face encounter between the provider and the patient
• Duration of treatment and adjustments made to the ventilator settings
• Patient’s diagnoses or reasons for ventilation
• Patient’s response to treatment

7. Billing guidelines

When billing for CPT 94004, ensure that the provider is delivering daily management of ventilator assistance to a patient in a long-term care facility. This code should not be reported with evaluation and management services. Payers typically bundle ventilator management codes into E/M codes, so it is important to review the provider’s notes to determine the appropriate code to report. If the notes primarily focus on ventilation management, report CPT 94004. If the notes describe an encounter where the provider performs ventilation management along with care for the patient’s other problems, report the appropriate E/M code if supported by documentation.

8. Historical information

CPT 94004 was added to the Current Procedural Terminology system on January 1, 2007. There have been no updates to the code since its addition.

9. Examples

1. A provider delivers daily management of ventilator assistance for a patient with chronic obstructive pulmonary disease (COPD) in a long-term care facility.
2. A provider adjusts the ventilator settings and monitors the response of a patient with respiratory failure in a nursing home.
3. A provider gradually reduces ventilatory support for a patient with neuromuscular disease to facilitate weaning in a long-term care facility.
4. A provider documents the duration of treatment and the patient’s response to ventilator assistance for a patient with amyotrophic lateral sclerosis (ALS) in a nursing home.
5. A provider continues to monitor and adjust the ventilator settings for a patient with spinal cord injury in a long-term care facility.
6. A provider delivers daily management of ventilator assistance for a patient with Guillain-Barré syndrome in a nursing home.
7. A provider adjusts the ventilator settings and monitors the response of a patient with pneumonia in a long-term care facility.
8. A provider gradually reduces ventilatory support for a patient with muscular dystrophy to facilitate weaning in a nursing home.
9. A provider documents the duration of treatment and the patient’s response to ventilator assistance for a patient with chronic respiratory failure in a long-term care facility.
10. A provider continues to monitor and adjust the ventilator settings for a patient with bronchopulmonary dysplasia in a nursing home.