ED Coding and Reimbursement Alert

Question: A 56-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. The notes indicate 43 minutes of critical care time. Outside of that 43 minutes, the physician performed CPR for 66 minutes before the patient finally stabilized. Is there any way to account for the "extra" CPR time?

North Carolina Subscriber

Answer: No. CPR is not a time-based code, and you are supposed to report the same code regardless of total CPR time. 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 or critical care: CPR is separately reportable from critical care, meaning you must carve out CPR minutes when counting time for 99291 and +99292 (- each additional 30 minutes [List separately in addition to code for primary procedure]). In the scenario above, you may report the 45 minutes of critical care and the 66 minutes of CPR. You cannot, however, count the minutes spent in CPR both ways. Remember to include the statement that the critical care time was carved out of all separately billable procedures.