ED Coding and Reimbursement Alert

Question: What are the time requirements associated with CPR code 92950?

Answer: Code 92950 (Cardiopulmonary resuscitation [eg, 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).

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. However, 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.

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.