# Confused on what to code



## Gemini18 (Dec 31, 2009)

I am auditing a record where a 54 year old female patient came into the ER (12/1/09) with sudden complaint of confusion and weakness.  She reported she had some chest pain the prior day.  Pt has a history of coronary artery disease and is S/P CABG.  Her WBC is 11,500 with 33 bands, urinalysis reveals 3+ bacteria.  BP is 42/22. Pt is suspected of significant sepsis with metabolic acidosis.

She was placed in ICU and started on dopamine, about 3:00pm. She was also given IV Zosyn and IV vancomycin in the ER. Blood cultures were collected.  About 10:00pm patient suddenly went into cardia arrest. After considerable resuscitation efforts, she developed sinus tachycardia.  With Levophen for blood pressure support, she had a systolic blood pressure of 120.  Pt was intubated.  The prior day family said patient had a temperature of 105.

After 15-20 minutes, pt arrested again. She was revived with considerable resuscitative efforts.  She again about 20 mins after the recovery went into bradycardia, loss of bp and responded to resuscitative efforts.  The oulook was ominous.  Pt had a very poor prognosis.  She continued to decline with cardiac arrest on the basis of severe septic state.

Family opted for DNR status.  Measures were continued, pt again arrested and lost her bp and heart rate.  Patient expired due to severe sepsis.

The timing for the whole process was not recorded but yet it was coded as a level 2 CC.

What should I coded this as?


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## LTibbetts (Dec 31, 2009)

Do you mean a critical care code? If so, the time HAS to be documented in order to charge critical care codes. Check your critical care section in your ICD-9 book again and you'll see what I mean. You may have to go back to the provider. Isn't there an event record somewhere in her chart that documents all of these life saving efforts? If critical care is not what you mean, then I apologize


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## LTibbetts (Dec 31, 2009)

Also, check the ACEP website for a lot of good critical care coding guidelines and information. It is a very informative website.


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## FTessaBartels (Jan 6, 2010)

*Time spent with CPR*

I am also confused by your statement that this was coded as "level 2 CC" ... If you mean critical care there are no "levels."  It is entirely based on time spent providing critical care.  99291 is for the first hour of critical care; 99292 (add-on code) is used for each additional 30 minutes. 

Time MUST be recorded in order to bill the critical care codes. 

Also ... *if* they are *separately coding *the resuscitation (CPT 92950) the time spent in CPR *CANNOT *be counted as critical care time!

Hope that helps.

F Tessa Bartels, CPC, CEMC


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