Pulmonology Coding Alert

Question: How should I code medical necessity for a cardiac resuscitation in the hospital setting? What E/M code should I use for this procedure for a patient in the intensive care unit (ICU)? What about resuscitation of a patient in the physician's office?

Montana Subscriber

Answer: The diagnosis code for cardiac resuscitation is 427.5 (Cardiac arrest [cardiorespiratory arrest]). The physician would report 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest]), regardless of place of service.

If the physician also provided critical care on that same day, he or she may report 99291 for the first 30 to 74 minutes and +99292 for each additional 30 minutes. Also report the diagnosis(es) for which he or she rendered the critical care. Because 92950 is a separate service, the time spent providing CPR should not be added into the critical care time. The physician should clearly document both services in the patient's chart and append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99291.

If the patient arrested in the physician's office and the doctor provided other services in addition to the CPR, he or she may also bill for the office visit, EKG, etc., as appropriate. The physician should report the diagnosis(es) relevant to the office visit and/or diagnostic studies and report 427.5 for 92950.