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AHESLER

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I work for an urgent care office and have a question on whether or not to bill an E/M. If a patient arrives at our facility unconscious or collapses on the floor in the waiting room and is found not breathing and with no pulse and CPR and other life saving methods are performed, should there be an E/M charged along with the CPR? The doctor documents on the chart after the patient has been taken by squad to the ER but rather than doing an actual exam I think the situation is assessed and most of the time is spent trying to save the persons life rather than evaluate and manage. Are there rules for these types of situations or does anyone have any helpful information on how I can determine if the E/M was actually done or not?
Thanks
 
I don't believe you can bill an additional E/M. If the provider only did the CPR, there is no medical necessity for the E/M. What are the components of the history? Exam? MDM? 3 of 3 or 2 of 3 still have to be met and doing chest compression's until the ambulance can gets there doesn't not qualify for an office visit, in my opinion! :)

Hope this helps.
 
Probably not a regular E/M visit, but I was thinking about a Critical Care Code. If the provider documented the time spent on the patient, then 92950 (CPR) and perhaps 99291 (if more than 30 minutes was spent on Critical Care) could be appropriate. Remember that Critical Care codes don't have to be in the hospital in order to be billable. This all depends on what the provider actually did and what they documented.
 
I'm fairly certain there is a verbiage that states that you cannot bill critical care for 92950 if that is the sole reason the provider is helping the patient.

https://www.aapc.com/blog/24587-ten-commandments-of-coding-critical-care-in-the-er/

If you look at #7 and #9, the time stops for critical care when the start of CPR begins. Time spent for resuscitation is not included in critical care time. So the provider would still need to go above and beyond the procedure in order to bill for an evaluation and management or critical care.

Yay for gray areas of coding!
 
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bdcoyne8 said:
I'm fairly certain there is a verbiage that states that you cannot bill critical care for 92950 if that is the sole reason the provider is helping the patient.

https://www.aapc.com/blog/24587-ten-commandments-of-coding-critical-care-in-the-er/

If you look at #7 and #9, the time stops for critical care when the start of CPR begins. Time spent for resuscitation is not included in critical care time. So the provider would still need to go above and beyond the procedure in order to bill for an evaluation and management or critical care.

Yay for gray areas of coding!
Click to expand...


Coding must support what was performed and documented. Because the information given was somewhat vague: "other lifesaving methods", apart from the provider performing CPR; the statement remains like I mentioned: "This all depends on what the provider actually did and what they documented.".

To put this in other terms:

  • If the provider's sole purpose was to perform CPR until the EMTs arrived, and didn't really do much else, then I absolutely agree on billing 92950 only.
  • If the provider performed CPR and also performed Critical Care (CC) services for at least 30 minutes once the patient had somewhat stabilized, then 92950 + 99291 might be appropriate. Again, actual services performed and documentation would dictate the codes.
  • If the provider performed CPR and also performed Critical Care (CC) services for under 30 minutes once the patient had somewhat stabilized, then 92950 + another E/M might be appropriate, depending on what else was performed.

Different scenarios would beg for different codes, however having more knowledge on what would be appropriate on either situation is a win for any coder. I do agree with the time count dedication, can only use time actually spent on CC, and the timer stops when doing anything else non-CC, like CPR or regular E/M.

And yes, the gray areas of coding help us stay awake (and interested!).
 
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Thank you for all of the responses and information! This will be great for future visits in question. On the most recent visit I had, the doctor went to the vehicle in the parking lot where the patient was unresponsive. The doctor and MA immediately started CPR and later used an AED. When the squad arrived they took over and transported the patient to the ER. The medical record gives a very detailed HPI starting with the wife running into the office asking for help and also documents all of the patients happenings that led up to the event. She gives other info such that he is diabetic and has HTN. The other histories were pulled up from the patients past visits and reviewed by the doctor. The doctor records an ROS and documents in the exam area that the patient was found unresponsive, no pulse, no heartbeat. He marked abnormals in three systems in the exam and details everything that occurred in the parking lot. Is this acceptable for an E/M? Can you count the history if it was not given at the time of service?
Thanks!
 
You are allowed to include the time spent face-to-face with family.

If it is a new patient, you would still need an MDM to support the visit.

I don't know if this is the appropriate way to code things but the way I do it is - If I code for this, and I am asked why I feel it is justified, could I justify it and am I confident with justification? If I were to go to court, would I know that what I did was right and coded correctly?

It's harder to justify a code if you aren't certain that it meets. But if you feel you can stand in front of a provider or a judge and say, "Yep, this is correct and this is why", then go for it! Coding isn't black and white. It's always up for interpretation. You just have to know that you are meeting coding guidelines to the best of your abilities and you protect yourself and your provider.

If you do code for this, it would be a low level visit. It still has to go ABOVE and BEYOND the CPR. If the presenting problem is the non responsive patient that resulted in CPR, does that meet a separate identifiable office visit? If you feel yes, go for it!
 
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