ED Coding and Reimbursement Alert

Question: One of our ED physicians performed CPR on a 55-year-old patient who came into the facility with symptoms of cardiac arrest. Thirty minutes later, the patient arrested again, and the same physician performed CPR a second time. How should we bill for this?

Michigan Subscriber

 
Answer: In this situation, you cannot bill CPR (92950, cardiopulmonary resuscitation [e.g., in cardiac arrest]) twice for the same physician. It might be possible to use modifier -59 (distinct procedural service) appended to the second CPR (92950) to indicate it was performed twice. Individual payer regulations may not allow this, so contact your local payers for directions. 
 
Another possibility is to bill the CPR for the first encounter and then bill critical care (99291, critical care evaluation and management of the critically ill or critically injured patient; first 30-74 minute) for the second encounter, provided the time constraints met the 30-minute criterion for using that CPT code.