ED Coding and Reimbursement Alert

Question: A 65-year-old disabled patient presented to the ED with nausea, vomiting, and diarrhea, along with extreme weakness. While staff was initiating an IV and blood draw, the patient went into full cardiopulmonary arrest. CPR was initiated and after a lengthy effort vital signs were restored. The notes indicate 43 minutes of critical care time outside of separately billable procedures. Upon reviewing the chart, outside of those 43 minutes, the physician performed CPR for 36 minutes before the patient finally stabilized. Can I get credit for the CPR time in addition to critical care?

South Carolina Subscriber

Answer: CPR is not included in the codes bundled into critical care found in the list relating to 99291. Additionally, in this case the physician met the threshold requirement for critical care time net of separately billable procedures. Therefore, you may report both if the documentation supports both services.

On the claim report the following:

• 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the critical care
• 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest]) for the CPR
• 427.5 (Cardiac arrest) appended to 99291 and 92950 to represent the patient’s heart attack.

CPR can be separately reportable from critical care but only if you deduct the time spent in performing CPR when counting up time for 99291. In the scenario above, you may report the 43 minutes of critical care and the 36 minutes of CPR. However, you cannot count the minutes spent in CPR towards critical care. Remember to include the statement that the critical care time was net of all separately billable procedures.