Billing and Coding: Cardiac Arrest

[thegenius]

What is the right way to write your chart for maximum B&C (billing and coding) for a cardiac arrest that expires. We have coders at my hospital and I'm not sure how they do it.

Scenario:
- Pt comes in undergoing CPR.
- You perform CPR for 30 minutes.
- You call time of death 30 minutes after pt arrives.
- Let's say you spend 30 minutes writing the chart and talking to family.

For above, should all CPT / coding be
- 99285 E&M 5
- 99291 CC Time (60 mins)
- 92950 CPR (30 mins) - a procedure

What if there is a tube involved, say it takes 3 mins. Would CPT codes now be
- 99285 E&M 5
- 99291 CC Time (60 mins)
- 92950 CPR (27 mins) - a procedure
- 31500 Tube (3 mins) - a procedure

Or is CPR still 30 mins? Aren't procedures independent of other procedures or CC time?

---

Members don't see this ad.

 

[HoosierdaddyO]

Critical care time is not included during cpr and certain procedures like intubation and and Triple lumen placement. You need to document that you supervised cpr for a certain length of time and the same with the procedures. And if there was critical care time before the actual arrest than you can do that as well. But cpr billing is quite high to begin with that unless there was actually hypotension or bradycardia for 30 min prior to the arrest it’s hard to bill for cc time. But you need to document plainly that cardiac arrest was performed which is billed different that Crit care time. Anything after the patients pulse stops is no longer billable other than notes (I am not sure about family discussion) if it was during the patient being alive and was goals of care then yes, but if it was to deliver the bad news I don’t think that’s Crit care

 

[HoosierdaddyO]

For example you have a patient that is sick as **** coming in via ems, hypotensive and tachy for 35 min you work on him to get him stable and then codes for the next following 40 min!!! And during that 40 min code you intubated and placed a line!!! And the code was called and patient died and then had a discussion with the fam about the results!!
CC: 35 min (include the time for your note as well)
Cpr: 40 min
Separate bill for intubation and central line

CC time and cpr/codes don’t count for the same concurrent time... it’s one or the other... it’s complicated but hope I helped more than I didn’t lol

 

[southerndoc]

Work RVU's are 3.80 for 99285, 4.50 for a 99291, 2.33 for a 31500, and 4.00 for 92950.

A properly documented CPR note, intubation note, and chart would be billed as a 99285 + 92950 + 31500. That would get you a 10.13 wRVU's. Billing as a critical care chart would replace the 99285 code and won't allow you to bill 92950 (since critical care time is exclusive of most procedures). Billing as a critical care chart would only get you 6.33, which is debatable because technically your intubation time must be subtracted from your critical care time and therefore won't qualify for 30 minutes. You would need to count additional time (discussion with family, documentation, etc.) and properly document this to withstand an audit if you in the rare chance you are audited.

Now if you resuscitate the patient after intubation and spend 30 minutes of critical care, then you can bill for 99291, 31500, and 92950 which gives you 10.83 wRVU's. Keep in mind that there is no time limit on CPR. Even if you do 3 minutes of compressions and are managing the resuscitation, you can still bill for 92950.

What most people don't realize is that if you do CPR for 10 minutes, get ROSC, place CVL, and had intubated the patient, and if the patient spends an hour in the ED, you can bill for everything.

People also don't realize that 92950 is for CPR and not ACLS. Therefore, defibrillation/cardioversion is billed separately (sorry, I don't remember their codes or wRVU's).

You need to add the correct modifier to the procedure (usually -25, sometimes -59) to bill for the E&M and CPR.

Note that you do NOT need to personally perform chest compressions to bill the 92950 code. You only need to manage it and properly document it ("CPR was performed by ED team/LUCAS device under my direct supervision at all times.") I have a CPR canned text that adds a lot more information.

 

[RoyBasch]

People also don't realize that 92950 is for CPR and not ACLS. Therefore, defibrillation/cardioversion is billed separately (sorry, I don't remember their codes or wRVU's).

Excellent, I never knew that.