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Carrie Nienberg, RN, CPC, Director of Clinical Operations

On August 25th, 2020, CGS conducted a webinar on the National Coverage Determination (NCD) coverage criteria and documentation requirements for ventilators. During the webinar, the following questions were asked by attendees that required follow-up to the medical directors for clarification. In sharing their responses, it will give you guidance when reviewing documentation prior to setting up a ventilator patient.

Question: If the hospital did not do an ABG, only VBG, would the VBG help qualify the patient for a ventilator?

Answer: ABG is the only acceptable method listed for measurement of CO2.

Question: Is ETCO2 results valid for CO2 retention versus an ABG?

Answer: Same answer; only an ABG is the acceptable method listed for measurement of CO2.

Question: Can we provide a multi-function ventilator at the bedside and provide a second ventilator on a wheelchair if needed?

Answer: No. Products coded E0467 are small and portable thus there is no necessity for a second ventilator.

The two major takeaways from this are: 1) Be sure you have ABGs supporting elevated CO2 levels rather than VBGs or ETCO2 and 2) If you are providing a second ventilator, your documentation must indicate why one won’t meet the beneficiary’s respiratory needs, keeping in mind how portable they now are. In their response for multi-function ventilator, we also take this to include any home ventilator.

Unsure if your documentation supports your ventilator claims? The van Halem Group can help!

From clinical prescreens of your claims to conducting proactive audits on a one-time or monthly basis, we have solutions to ensure your ventilaor claims meet technical and clinical guidelines. Contact us to learn what our team of experts can do for you!

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