Practice Management Alert

Question: What are the time requirements associated with CPT® code 92950?

Hawaii Subscriber

Answer: Code 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest]) involves the provision of cardiac life support including chest compressions and ventilation of the patient to restore and maintain the patient’s respiration and circulation after cessation of heartbeat and breathing. Basic CPR consists of assessing the victim, opening the airway, restoring breathing (through mouth-to-mouth, bag-valve-mask, or other methods), and restoring circulation (through closed chest cardiac massage, for example), says Todd Thomas, CPC, CCS-P of ERcoder, Inc in Edmond, OK.

The CPT® book does not include any specific instruction about CPR other than the code descriptor, but there are references to supporting articles in the CPT® Assistant® over the years. For example, there is no mention of any time component to CPR in the CPT® book.

Hopefully the procedure will quickly result in return of heart and lung function, but that is not always the case. It is not uncommon to continue CPR for an extended time to keep the patient viable while initiating other measures such as intubations or placing central lines to assist in the patient’s recovery.

It is also possible to have multiple rounds of CPR during the same patient encounter. The relative value units (RVUs) associated with CPR are robust with assigned work RVUs of 4.0 and total RVUs of 5.33 which would yield a Medicare payment of $190.84 under the 2016 physician fee schedule. That is actually higher than the value for the highest-level emergency department (ED) evaluation and management (E/M) code.

ED E/M code 99285 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient’s clinical condition and/or mental status: a comprehensive history; a comprehensive examination; and medical decision making of high complexity…) weighs in with a work RVU of 3.80, total RVUs of 4.90 and a Medicare payment of $175.44. When you consider the intensity of the service of trying to bring a patient back to life, that does not seem unreasonable, but at the same time, more than a few minutes of CPR time should be provided before reporting the code, says Thomas.

Critical care alert: CPR is not included in the critical care preamble list of services that are bundled into the value of code 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes), and therefore identified as not separately reportable. So, as long as the respective requirements for each service are satisfied and evident in the medical record, you might report both 99291 and 92950.

However, since it is a separately reportable service, the time spent providing CPR cannot be counted toward calculating total critical care time. Your critical care time attestation in that scenario should mention the critical care time reported was net of any other separately provided services

Tip: When CPR is provided for an extended time, and backing that time out of your critical care clock results in remaining time below the 30-minute minimum time threshold, consider reporting CPR along with an evaluation and management (E/M) level of service based on the documented history, physical exam, and medical decision-making performed. It is reasonable that a complete history might not be available to the provider but attempts should be made to gather history from available sources such as EMS or other family members, Thomas explains.