ED Coding and Reimbursement Alert

Question: Is it appropriate to assign cardiopulmonary resuscitation (CPR) codes in addition to critical care when CPR is performed?

Montana Subscriber
 
Answer: Yes, CPR (92950, cardiopulmonary resuscitation [e.g., in cardiac arrest]) may be reported separately in addition to other services like critical care (i.e., 99291, critical care, evaluation and management of the critically ill or injured patient; first 30-74 minutes; and 99292, each additional 30 minutes [list separately in addition to code for primary service]) when performed during the same encounter. Because an ED visit is considered an E/M service, Medicare and other payers may require modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) be appended to the visit code.
 
Coders must recognize, however, that time spent performing CPR should be subtracted from the total time reported as critical care. To count the time spent as critical care and bill the services separately is double billing. Therefore, it is very important for the physician to indicate the time taken for CPR and the time taken for critical care. Merely stating that CPR and critical care services were provided does not indicate the time allotted to each service.
 
In addition, CPT considers 11 specific services bundled into critical care, and emergency physicians are not allowed to report these separately. Time spent performing these services should be factored into the critical care coding:

 1. interpretation of cardiac output measurements (93561, 93562)
 2. chest x-rays (71010, 71015, 71020)
 3. blood gases (e.g., carbon dioxide 82803)
 4. blood draw for specimen (G0001)
 5. data stored in computers, (e.g., ECGs, blood pressures, hematologic data, 99090)
 6. gastric intubation (91105)
 7. pulse oximetry (94760, 94762)
 8. temporary transcutaneous pacing (92953)
 9. ventilator management (94656, 94657, 94660, 94662)
 10. vascular access procedures (36000, 36410, 36600)
 11. family medical psychotherapy (90846).

Reader Questions and You Be The Coder were reviewed by John Turner, MD, FACEP, medical director for coding and documentation at TeamHealth Inc. in Knoxville, Tenn.; and Tracie Christian, CPC, CCS-P, director of coding for ProCode in Dallas.