ED Coding and Reimbursement Alert

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 Mexico Subscriber

Answer: If your documentation provides two separate sessions of the same service, you could report the therapeutic service with 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest]) twice.

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 would also indicate two distinct sessions of the same service.

But you will have trouble justifying two different sessions of the same service if the physician performed both in the ED during the same encounter. When you bill distinct sessions, use modifier -76 (Repeat procedure by same physician) on the second session.

Don't append modifier -53 (Discontinued procedure) to 92950; CPR often fails, and ultimately the physician always stops the CPR. Ten minutes of CPR typically involves one or two rounds of medications and oversight of chest compressions and therefore qualifies as a legitimate full service.

-- Reader Questions and You Be the Coder were reviewed by Michael  A. Granovsky, MD, CPC, FACEP, vice president of Medical Reimbursement Systems in Stoneham, Mass.