ED Coding and Reimbursement Alert

Question: Can we charge for CPR and critical care in the same encounter? I don't think Medicare will pay for both, but the physician has clearly documented his services for both.


Arkansas Subscriber

Answer: Yes, you can charge for both 92950 (Cardiopulmonary resuscitation) and 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) during the same session. There are no National Correct Coding Initiative edits in place for this code choice, and cardiopulmonary resuscitation is not bundled with 99291 in the CPT manual.

However, a recent CPT Assistant clarified that you do need to subtract all the minutes that CPR is ongoing from the critical care time. If, once you've done that, you still have a minimum of 30 minutes of critical care, reporting these codes together is legitimate and should receive reimbursement on appeal.
 
A documented statement along the lines of "XX minutes of critical care time was provided net of any separately billed procedures" is recommend in these cases.

CPT bundles certain procedures into the time the physician spends on critical care, but others are separately billable. You can earn separate reimbursement for these procedures: cardiopulmonary resuscitation, endotracheal intubation, initial pericardiocentesis, central venous catheter placement, chest tube, and electrocardiogram (EKG) interpretations. Other procedures performed during critical care, however, are included in 99291 and +99292 (... each additional 30 minutes): cardiac output measurements, chest x-rays, pulse oximetry, blood gases, gastric intubation, and temporary transcutaneous pacing.

Tip: Make sure the physician documents all the services he performed, and use a charge ticket to assist physicians in capturing all charges.
 
Keep in mind: Some claim check edits (which CMS carriers don't commonly use) will require a second diagnosis to support the medical necessity in these situations. This distinction is not one of correct coding, but of how to get proper reimbursement from specific payers.