ED Coding and Reimbursement Alert

Question: A patient went into cardiac arrest in our ED waiting room. The physician performed CPR and resuscitated the patient, who was then admitted to critical care. Can we report the CPR or is it included in the critical care?

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Answer: When clinicians in the ED perform CPR, you’ll typically report 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest]). This code describes the provision of cardiac life support including chest compressions and ventilation of the patient to restore and maintain his respiration and circulation after cessation of heartbeat and breathing.

CPR is not included in the critical care code preamble list of services that are bundled into the value of the critical care codes. Therefore, as long as the respective requirements for each service is satisfied and evident in the medical record, both the critical care code 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 could mention the critical care time reported was net of any other separately provided services.

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. “If the physician manages the cardiopulmonary resuscitation (and is present face-to-face), the physician may report code 92950,” the AMA said in the Sept. 2012 CPT^® Assistant. “It is not required that the physician performs the actual chest compressions and/or mouth-to-mouth or bag-to-mask ventilation in order to report code 92950.”

Keep in mind that you can’t report a critical care code simply because you performed CPR. If the patient was admitted to critical care following the ED physician’s administering of CPR and the ED physician does not see the patient again (because another physician takes over his critical care), then you should report the CPR code and not the critical care code.