ED Coding and Reimbursement Alert

Question: The emergency department (ED) physician receives a call to the floor for a code blue. She has never seen the patient before, and performs cardiopulmonary resuscitation (CPR). I know we can bill for the CPR, but should I also report an evaluation and management code - and if so, which one? What if she saw the patient in the ED earlier that day, the patient was then admitted, and our physician received the "code blue" call four hours later?

Georgia Subscriber

Answer: If the physician indeed performed and documented an E/M service in addition to the CPR, you should report the appropriate E/M code. In this case, critical care may be the best choice if time thresholds are met. If the physician spent 30 minutes or more with the patient, you could report 99291 (Critical care, E/M of the critically ill or critically injured patient; first 30-74 minutes), and if she spent 75 minutes or more, you could report +99292 (... each additional 30 minutes).

Remember, though, that you cannot use ED E/M codes (99281-99285) for services rendered outside the ED. You should also keep in mind that unless the patient's complaints are for two entirely separate problems, you should not report two separate E/M services in the same day.

If your physician did not deliver 30 minutes of critical care -- in addition to the CPR treatment -- then, depending on the supporting physician documentation, you may be able to report one of the three subsequent hospital care codes:

99231 -- Subsequent hospital care, per day, for  the E/M of a patient, which requires at least two of these three components: a problem-focused interval history, a problem-focused examination, and medical decision-making (MDM) that is straight-forward or of low complexity

99232 -- ... an expanded problem-focused interval history, an expanded problem-focused examination, and MDM of moderate complexity

99233 -- ... a detailed interval history, a detailed examination, and MDM of high complexity.