ED Coding and Reimbursement Alert

What are the time requirements associated with CPT® Code 92950?

Cardiopulmonary resuscitation (CPR) is one of the more dramatic procedures performed in the ED because it is used when the patient stops breathing or their heart stops.  Do you know the rules for when and how you can report this literally lifesaving service?

Code 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest]) involves the provision of cardiac life support including chest compressions and ventilation of the patient to restore and maintain the patient's respiration and circulation after cessation of heartbeat and breathing. Basic CPR consists of assessing the victim, opening the airway, restoring breathing (through mouth-to-mouth, bag-valve-mask, or other methods.), and restoring circulation (through closed chest cardiac massage, for example), says Todd Thomas, CPC, CCS-P of ERcoder, Inc in Edmond, OK.

The CPT^® book does not include any specific instruction about CPR other than the code descriptor, but there are references to supporting articles in the CPT® Assistant^® over the years. For example, there is no mention of any time component to CPR in the CPT^® book.

Hopefully the procedure will quickly result in return of heart and lung function, but that is not always the case. It is not uncommon to continue CPR for an extend time to keep the patient viable while initiating other measures such as intubations or placing central lines to assist in the patient's recovery.

It is also possible to have multiple rounds of CPR during the same patient encounter. The relative value units (RVUs) associated with CPR are fairly robust with assigned work RVUs of 4.0 and total RVUs of 5.33 which would yield a Medicare payment of $190.84 under the 2016 physician fee schedule. That is actually higher than the value for code 99285 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history; a comprehensive examination; and medical decision making of high complexity...) with a work RVU of 3.80, total RVUs of 4.90 and a Medicare payment of $175.44. When you consider the intensity of the service of trying to bring a patient back to life, that does not seem unreasonable, but at the same time, more than a few minutes of CPR time should be provided before reporting the code, says Thomas.

Both CPR and Critical Care Can Be Reported for the Same Patient Encounter?

CPR is not included in the critical care code preamble list of services that are bundled into the value of code 99291 and therefore identified as not separately reportable.  So, as long as the respective requirements for each service are satisfied and evident in the medical record, both 99291 and 92950 could be reported.

However, since it is a separately reportable service, the time spent providing CPR cannot be counted toward calculating total critical care time. Your critical care time attestation in that scenario should mention the critical care time reported was net of any other separately provided services

Tip: When CPR is provided for an extended time, and backing that time out of your critical care clock results in remaining time below the 30 minute minimum time threshold, consider reporting CPR along with an ED E/M level of service based on the documented history, physical exam, and medical decision making performed. It is reasonable that a complete history might not be available to the provider but attempts should be made to gather history from available sources such as EMS or other family members, Thomas explains.

Who Has to Perform the Chest Compressions or Ventilation of the Patient?

The physician does not have to physically perform the chest compressions or ventilation of the patient, as long as she is physically present and directing the provision of CPR services. According to the AMA "From a coding perspective, indeed the physician may report 92950 whether he/she is actually performing compressions or ventilation or directing these activities while other staff is actually performing cardiopulmonary resuscitation," says Thomas.