Cardiology Coding Alert

Question: Our cardiologist was making rounds at the hospital today when he responded to a "STAT" call for a cardiac arrest patient and performed CPR. She was the roommate of one of our patients, but we had never seen her before. The patient's admitting physician wants to bill his inpatient code for that day, so how do we get reimbursed for responding to the STAT call? Washington, D.C., Subscriber Answer: You should report 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest]) for the cardiologist's work. This will not interfere in any way with the bill that the patient's regular physician submits for his inpatient hospital visit.

Ask your physician if he spent any time after the resuscitation attending to the patient, because the patient's condition meets the CPT definition of one who is critically ill (impairment of one or more vital organ systems such that there is a high probability of imminent or lifethreatening deterioration in the patient's condition). Critical care codes are time-based, so your physician must have spent at least 30 minutes of noncontinuous time providing care to the patient to bill 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes). 

To report a critical care code, the cardiologist does not need to provide all of his care at the bedside. His service may include the following activities as long as the physician provided the services on the patient's floor or unit: reviewing test results or imaging studies, discussing the critically ill patient's care with other medical staff, or documenting critical care services in the medical record. If your cardiologist performed any of these activities, he should count that time in addition to any time he spent providing bedside care to the patient.

Be careful not to include the time that the cardiologist spent resuscitating the patient as a part of your critical care calculations. Insurers do not bundle 92950 into critical care, so you can separately report the CPR.