EM Coding Alert

Question: A patient became unresponsive in the ED and the physician began critical care but then quickly had to perform CPR. After just a few minutes of CPR the family changed the code status to do not resuscitate (DNR). A morphine drip was started, and the patient was allowed to slowly pass away without any interventions. How should we code this scenario? It started as critical care but then quickly involved CPR followed by simply very basic comfort care.

Indiana Subscriber

Answer: Since the physician did not provide at least 30 minutes of critical care outside of the CPR, you should not report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes ...) for this encounter. The CPR time would have to be subtracted from the total critical care time, further limiting the critical care.

Do this: On the claim, choose a 9928x ED E/M code for the service based on encounter notes; your scenario is likely a 99285 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient’s clinical condition and/or mental status: a comprehensive history; a comprehensive examination; and medical decision making of high complexity ...) encounter.

Report any separately identifiable procedures as well after appending a 25 modifier to the E/M code.