Mountain State Medical Policy Bulletin
Section: Visits
Number: V-11
Topic: Ventilatory Assistance (Respirator Care)
Effective Date: January 1, 2006
Issued Date: January 2, 2006
Date Last Reviewed: 01/2006

General Policy Guidelines

Indications and Limitations of Coverage

Ventilatory assistance is applicable to patients of all ages, as well as neonates who are on respirators.

Claims reporting only ventilatory assistance or respirator care should be processed under codes 94656-94662. However, when critical care (codes 99291-99292), pediatric critical care (codes 99293-99294), neonatal critical care (codes 99295-99296), or subsequent intensive care (codes 99298-99300) and ventilatory assistance are reported on the same day by the same doctor, the charges for the ventilatory assistance should be denied, with payment being made for the critical care or neonatal intensive care, only. A participating, preferred, or network provider may not bill the patient separately for the ventilatory assistance.

Description

Ventilatory assistance is a form of critical care not to be distinguished from other forms of prolonged detention or critical care for other conditions.

Procedure Codes

946569465794660946629929199292
992939929499295992969929899299
99300     

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Refer to General Policy Guidelines

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

PRN References

12/1996, Do not range date ventilation management

References

View Previous Versions

[Version 001 of V-11]

Table Attachment

Text Attachment

Procedure Code Attachment


Glossary




This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.