ED Coding and Reimbursement Alert

You Be the Coder:

Master Modifiers for CPR

Published on Thu May 01, 2003

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: One of our ED physicians spent critical care time with an inpatient on two separate occasions on the same day. Both times, the care involved CPR. The second time the physician performed CPR, he discontinued the CPR after 10 minutes at the family's request. Should I append two modifiers, -76 and -53, to the second CPR code?

New York Subscriber

Answer: You should report the therapeutic service 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest]) twice if your documentation shows distinct sessions of the same service. To charge this code with two units, you should have documentation that indicates that the repeated services are very distinct. For example, your documentation could show different locations within the hospital, such as initially in the ED and later in the intensive care unit (ICU). If the physician had to go to the ICU twice, that too would indicate two distinct sessions of the same service.

You will have trouble, however, justifying two different sessions of the same service if they were both performed in the ED during the same encounter. If the sessions really are distinct, use modifier -76 (Repeat procedure by same physician) on the second session.

You do not have to append modifier -53 (Discontinued procedure). Unfortunately, many times CPR is unsuccessful for one reason or another, and ultimately "the code is called" and the CPR stopped. Ten minutes of CPR would likely involve one or two rounds of medications and oversight of chest compressions, and therefore qualify as a legitimate full service.