ED Coding and Reimbursement Alert

Question:  A patient arrives at the ED dead on arrival; the emergency medical technician (EMT) informs the physician that the patient "appeared to be having a heart attack when we arrived, and expired during CPR [cardiopulmonary resuscitation]. The ED physician tries CPR again for three minutes, but documented no history, physical exam, or medical decision making; the nurse's notes only said "DOA, physician pronounces px dead." Can I bill 99281 and 92950 for this encounter? West Virginia Subscriber

Answer: You cannot report 99281 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making ...) since the physician could not perform the three components of an ED E/M service (history, examination, medical decision making).

You might consider reporting 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest]) for the CPR with 427.5 (Cardiac arrest) appended to represent the patient's heart attack.

Caveat: Many EDs do not bill at all for patients who present DOA and cannot be revived. Ask your physician, or physician group, if they have a policy on DOA patients before considering this claim.