Mechanical Ventilation. The ICD-10-PCS provides three codes to describe the duration patients are on mechanical (respiratory) ventilation as follows: 5A1935Z Respiratory ventilation, less than 24 consecutive hours 5A1945Z Respiratory ventilation, 24-96 consecutive hours 5A1955Z Respiratory ventilation, greater than 96 consecutive hours ...
See Coding Clinic, Second Quarter 1992, pp. 13–14. The number of hours the patient receives continuous invasive mechanical ventilation, such as continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP), when delivered through an endotracheal tube or tracheostomy. See Coding Clinic, Fourth Quarter 2008, p. 187.
Dependence on other enabling machines and devices. Z99.89 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2020 edition of ICD-10-CM Z99.89 became effective on October 1, 2019. This is the American ICD-10-CM version of Z99.89 - other international versions of ICD-10 Z99.89 may differ.
Noninvasive positive pressure ventilation as a weaning strategy for intubated adults with respiratory failure. Cochrane Database Syst Rev. 2003; (4):CD004127. Buzi A, Coblens OM, MacGillivray M, Elden L. The use of noninvasive positive pressure ventilation following pediatric tonsillectomy.
Status code categories V46. 1 (ICD‐9, HCC 82) and Z99. 1 (ICD‐10, HCC 82) are for use when the patient is dependent on respirator (ventilator). This code category also includes weaning from a mechanical ventilator and encounters for respiratory (ventilator) dependence during power failure.
ICD-10-PCS code 5A1955Z for Respiratory Ventilation, Greater than 96 Consecutive Hours is a medical classification as listed by CMS under Physiological Systems range.
ICD-10 code Z99. 89 for Dependence on other enabling machines and devices is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
Dependence on respirator [ventilator] status Z99. 11 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
ICD-10-PCS Code 5A09357 - Assistance with Respiratory Ventilation, Less than 24 Consecutive Hours, Continuous Positive Airway Pressure - Codify by AAPC.
Dependence on other enabling machines and devices The 2022 edition of ICD-10-CM Z99. 89 became effective on October 1, 2021. This is the American ICD-10-CM version of Z99.
ICD-10 Code for Atherosclerotic heart disease of native coronary artery without angina pectoris- I25. 10- Codify by AAPC.
Z99.81Z99. 81 - Dependence on supplemental oxygen. ICD-10-CM.
ICD-10 code Z74. 09 for Other reduced mobility is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
Codes for observation are reported as the primary code when used with the exception of code Z05 which may be first listed or as an additional code sequenced after a code from category Z38. Aftercare codes are used to report the confirmed care the patient receives after the acute phase of treatment.
The two main types of mechanical ventilation include positive pressure ventilation where air is pushed into the lungs through the airways, and negative pressure ventilation where air is pulled into the lungs.
Adaptive servo-ventilation (ASV), a bilevel PAP system with a backup rate feature, uses an automatic, minute ventilation-targeted device (VPAP Adapt, ResMed, Poway, CA) that performs breath-to-breath analysis and adjusts its settings accordingly. Depending on breathing effort, the device will automatically adjust the amount of airflow it delivers in order to maintain a steady minute ventilation. Most studies on the use of ASV have investigated its use for heart failure patients with central apnea or Cheyne-Stokes respiration (Teschler et al, 2001; Pepperell et al, 2003; Topfer et al, 2004; Pepin et al, 2006; Kasai et al, 2006; Zhang et al, 2006).
An individual requires one type of respiratory assist device (e.g., a negative pressure ventilator with a chest shell) for part of the day and needs a different type of respiratory assiste device (e.g., positive pressure respiratory assist device with a nasal mask) during the rest of the day.
The single breath nitrogen test (SBNT) is a pulmonary function test that provides information on the evenness of distribution of ventilation and on closing volume. The test utilizes resident nitrogen (N 2) in the lung as the tracer gas, and a single inhalation of 100 % oxygen to cause a change in the N 2 concentration in the lungs. It is performed by having the subject breathe air normally through a mouthpiece, and after a single vital capacity inspiration of 100 % O 2, expire slowly and smoothly to residual volume. Expired N 2 concentration is then plotted against expired volume (single breath nitrogen washout curve). From this, information about the distribution of ventilation can be obtained. Similar measurements may be made using other tracer gases such as xenon, argon, or helium.
Clayton and colleagues (2019) noted that initial respiratory support with NPPV or high-flow nasal cannula may prevent the need for invasive mechanical ventilation in pediatric intensive care unit (PICU) patients with bronchiolitis. However, it is unclear if the initial choice of respiratory support modality influences the need for subsequent invasive mechanical ventilation. These researchers compared the rate of subsequent invasive mechanical ventilation after initial support with NPPV or high-flow nasal cannula in children with bronchiolitis. This trial included a total of 92 participating PICUs. Children less than 2 years of age were admitted to a participating PICU between 2009 and 2015 with a diagnosis of bronchiolitis who were prescribed high-flow nasal cannula or NPPV as the initial respiratory treatment modality. Subsequent receipt of invasive mechanical ventilation was the primary outcome. These investigators identified 6,496 participants with a median age 3.9 months (1.7 to 9.5 months); most (59.7 %) were male, and 23.4 % had an identified co-morbidity. After initial support with NPPV or high-flow nasal cannula, 12.3 % of patients subsequently received invasive mechanical ventilation, which was more common in patients initially supported with NPPV compared with high-flow nasal cannula (20.1 % versus 11.0 %: p < 0.001). In a multi-variate logistic regression model that adjusted for age, weight, race, viral etiology, presence of a co-morbid diagnosis, and Pediatric Index of Mortality score, initial support with NPPV was associated with a higher odds of subsequent invasive mechanical ventilation compared with high-flow nasal cannula (OR, 1.53; 95 % CI: 1.24 to 1.88). The authors concluded that in this large, multi-center database study of infants with acute bronchiolitis that received initial respiratory support with high-flow nasal cannula or NPPV, use of the latter was associated with higher rates of invasive mechanical ventilation, even after adjusting for demographics, co-morbid condition, and severity of illness. These investigators stated that a large, prospective, multi-center trial is needed to confirm these findings.
While NPPV is associated with fewer complications than endotracheal intubation (ET), it is relatively contraindicated after esophag ectomy due to potential injury to the anastomosis. These researchers created ex-vivo and in-vivo pig models to determine the pressure tolerance of an esophagectomy anastomosis and compared it to esophageal pressure during NPPV. These investigators created a stapled side-to-side, functional end-to-end esophago-gastric anastomosis. With continuous intraluminal pressure monitoring, they progressively insufflated the anastomosis with a syringe until an anastomotic leak was detected, and recorded the maximum pressure before leakage. These researchers performed this experiment in 10 esophageal specimens and 10 live pigs. They then applied a laryngeal mask airway (LMA) to 5 live pigs and measured the pressure in the proximal esophagus with increasing ventilatory pressures. The perforation was always at the anastomosis. The ex-vivo and in-vivo anastomoses tolerated a mean of 101 ± 44 cm H2O and 84 ± 38 cm H2O before leak, respectively. There was no significant difference between the pressure thresholds of ex-vivo and in-vivo anastomoses (p = 0.51). When 20, 30, and 40 cm H2O of positive pressure via LMA were delivered, the esophagus sensed 5 ± 4 cm H2O (25 %), 11 ± 11 cm H2O (37 %), and 15 ± 9 cm H2O (38 %), respectively. The authors concluded that the findings from their ovine model suggested that an esophagectomy anastomosis can tolerate a considerably higher pressure than is transmitted to the esophagus during NPPV. They stated that NPPV may be a safe alternative to ET after esophagectomy. These preliminary findings need to be validated in well-designed clinical trials.
The need for re-intubation after extubation and discontinuation of mechanical ventilation is not uncommon and is associated with increased mortality. Noninvasive positive pressure ventilation has been suggested as a treatment for individuals with respiratory failure following extubation.
The clinical utility of non-specific treatments (e.g., anti-inflammatory agents, bronchodilators, antibiotics, physiotherapy) has not been proven by clinical trials. Airway surgery should be avoided, and non-invasive ventilation may be employed as a temporary measure.
The purpose of this document is to provide Respiratory Therapy Departments with information on the relationship between Respiratory Department coding and billing and hospital reimbursement for noninvasive mechanical ventilation and other respiratory support modalities delivered in the inpatient hospital and outpatient emergency department settings.
APC: Ambulatory Payment Classifications (APCs) are the Medicare program’s method for paying for facility outpatient services. APC payments are made to hospitals when the Medicare outpatient is discharged from the Emergency Department or clinic. Medicare assigns each service (identified by CPT code) to an APC based upon clinical and cost similarity, and all services within an APC are paid at the same rate.
There is no reimbursement advantage to the hospital for the use of any particular method of non-invasive mechanical respiratory support in the Emergency Department or other hospital outpatient setting.