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 report two modifiers -- 76 (Repeat procedure by same physician) and 53 (Discontinued procedure) -- on the second CPR?

New York Subscriber

Answer: You should report the therapeutic service 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest]) twice if your documentation shows two distinct sessions of the same service. To charge this code with two units, you should have documentation that indicates that the repeated services are very distinct.

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, separated by a reasonable amount of time, that too would indicate two distinct sessions of the same service.

You will have trouble, however, justifying two different sessions, both in the ED during the same encounter, of the same service. If the sessions really are distinct, use modifier -76 on the second session.

You do not have to append modifier 53 (Discontinued procedure). Many services are unsuccessful for one reason or another, and usually stopped. Ten minutes of CPR would likely involve one or two rounds of medications and therefore, qualifies as a legitimate full service.