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ED Coding and Reimbursement Alert

Reader Questions:

Tread with caution if considering DOA billing

Published on Sat Nov 06, 2010

Question:  A patient arrives at the ED dead on arrival; the emergency medical technician (EMT) informs the physician that the patient "appeared to be having a heart attack when we arrived, and expired during CPR [cardiopulmonary resuscitation]. The ED physician tries CPR again for three minutes, but documented no history, physical exam, or medical decision making; the nurse's notes only said "DOA, physician pronounces px dead." Can I bill 99281 and 92950 for this encounter? West Virginia SubscriberAnswer: You cannot report 99281 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making ...) since the physician could not perform the three components of an ED E/M service (history, examination, medical decision making).You might consider reporting 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest]) for the CPR with 427.5 (Cardiac arrest) appended [...]
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