Vent category needs work

Revising codes, establishing guidelines good place to start
Monday, July 27, 2015

Everyone agrees there need to be changes to the vent product category, but they don’t agree on how.

“CMS uses a blunt tool to cut, indiscriminate of care,” said Gregory LoPresti, CEO of Upstate Home Care in Syracuse, N.Y. “We know that in the case of ALS and other neuromuscular patients, non-invasive vents keep them out of the hospital longer.”

CMS in June announced that it wants to overhaul the product category by creating two new codes for vents (one for non-invasive and one for invasive) and discontinuing five existing codes (E0450, E0460, E0461, E0463, E0464). 

While some providers say switching to two codes could streamline certain processes, others worry that grouping products with varying degrees of sophistication under one code could make it harder to get the best equipment for patients, say providers.

“If you are dumbing down the codes, maybe you can use a lesser product for that patient, and it’s really not meeting their needs,” said Bill Hart, director of clinical services for Auburn Hills, Mich.-based Advent Home Medical. “Maybe there need to be more codes and, depending on the patient, maybe there needs to be a higher reimbursement for a particular diagnosis.”

CMS’s proposal is driven by a spike in the use of non-invasive ventilation to treat sleep apnea—something that should rarely happen, say providers.

“We use non-invasive vents very specifically for neuromuscular and COPD patients where, clearly, standard Bi-level is not working,” said Brian Simonds, director of Baystate Home Infusion & Respiratory Services in Springfield, Mass. “We should have very low use of NIV for strictly sleep related issues.”

At the end of the day, CMS could solve a lot of problems if it provided clear guidelines on use of vents, say providers.

“They need to develop, with industry input, an appropriate local coverage determination and pay appropriately,” said LoPresti. “They are stuck on paying too much money rather than (solving the problem).”