ED Coding and Reimbursement Alert

Question: A patient presented to the ED down (in arrest). He was at the facility for 20 minutes, CPR was performed, etc., but he was nonresponsive and died. Because the encounter did not meet critical care time (i.e., at least 30 minutes), we reported 92950 and 99285. Our fiscal intermediary denied the claim, indicating that we did not document that the ED physician actually performed CPR. I am not aware of any situation in which the physician personally performs CPR. Is this correct?

California Subscriber

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Answer: The ED physician is in charge of the entire resuscitation effort and often does not personally perform CPR in the emergency department. Performing the compressions takes the physician away from the more important task of running the arrest and managing the patients care. Only rarely if there is no one else qualified available will the physician perform CPR.

Medicare states that the physician does not actually have to perform CPR to report 92950 (CPR, in cardiac arrest). Documentation must support that the physician was present and supervised the arrest, however. Private payers and Medicaid carriers may have rules differing from Medicare policy and CPT. Check with your payers for more information.