ED Coding and Reimbursement Alert

Question: Our ED physician got a call from an EMS worker who was en route to the hospital with a patient in cardiac. The patient had a brief period of CPR in the field and was then declared a priority four. He was brought to the ED and then to the morgue. Can I bill for the CPR that took place by EMS?


Kentucky Subscriber


Answer: Actually, you cannot report CPR in this scenario. The encounter does not meet the criteria for the code. What you may be able to do, however, is report a low-level evaluation and management service for the encounter.

Doctor must direct CPR in person: You can't use 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest]) for the physician's CPR direction because insurers require that the physician be face-to-face with the patient during CPR. The physician only advocated the CPR by phone in this instance, so it does not meet 92950 standards.
 
If, however, the physician was at the patient's bedside directly overseeing the EMS providers performing CPR, you could report 92950.

Supervision RVUs rolled into E/M: While there is a code for physician supervision of EMS (99288, Physician direction of emergency medical systems [EMS] emergency care, advanced life support), it has a -B- status code in Medicare's eyes.

This means that Medicare recognizes the code, but it includes the aggregate work (i.e., relative value units) for 99288 in the assignment of the RVUs for the E/M service the physician provides. 

Best bet: Depending on whether there is actually some history, physical exam, and medical decision-making documented, consider representing the entire encounter with an ED E/M service. Check the report to see what transpired during the session, then pick the appropriate E/M code. You can also report 99288 in addition to the E/M, but you almost certainly won't get paid for it.

Another option is not reporting anything at all for the encounter. When a patient arrives DOA, some physicians choose this route.