92950: How To Bill A Code Blue CPT® E&M 92950

Code Blue, when someones heart or lung stops and everyone comes rushing in to save you. A reader wants to know how to bill it:

Dear Happy, How do you bill/code for a Code Blue? Is this critical care or separate?

The answer is:  It depends on how long you spend.

Cardiac resuscitation has its own CPT® medical coding code:  CPT® code 92950.  According to the RUC committee the physician work component of the RVU system is worth 3.79 RVUs. Remember RVUs are what Medicare determines how much a physician gets paid. Every CPT® component has a physician work RVU, a physician practice expense RVU and a physician malpractice RVU component.  When I code someone at a hospital, I get paid 3.79 work RVUs + .84 practice expense RVUs + .28 malpractice RVUs.  For a grand total of 4.91 RVUs to perform CPR on a patient.  At about $35 per RVU, this works out to approximately $175.  Some codes take 10 minutes.  Some codes take 30 minutes.  Some take an hour.  I get $175 no matter what by billing 92950

Now, if I code the patient, the code ends and I proceed to perform critical care, separate and independent of the actual code resuscitation, I can also bill critical care time using the critical care code 99291 and critical care add on code CPT® 99292. 

If the patient codes a second time in the same day, I bill another CPR code 92950.  And on and on and on.

As long as the CPR code is being billed separate and independent of any critical care time you spend, you can bill both in the same day as long as your non CPR time is documented in the chart.  The first 30-74 minutes of critical care time gets billed as a 99291.  Every thirty minute increments in a calendar day gets billed as another 99292.

It's almost always worth your while to bill the CPR 92950 code (if it lasts less than 30 minutes)  and then bill critical care if you are going to take care of them after the code.  Why?  Because a 99291 code (the first 74 minutes of critical care) pays you 4.5 work RVU + 1.17 practice expense RVU + .21 malpractice RVU for a total of 5.88 RVUs for 30-75 minutes of work.  This is about $200.

So here are your scenarios:

1. You code someone and it lasts less than 30 minutes and  you do nothing else:  Bill a 92950 (CPR code)
2.  You code someone and it lasts less than 30 minutes, but you also do critical care time of between 30-74 minutes after the code has ended (often times because you are asked to consult on the patient, or it's your patient and you have to continue managing the patient in their critical care state.  Bill the 92950 CPR code and then bill a 99291 for the first 30-74 minutes you spend on critical care after the CPR has ended. 
3. You code someone and it lasts between 30-74 minutes and you do no more work on the patient.  Bill a critical care 99291 stand alone code.  You can't bill both critical care (99291) and a code CPT® (92950) simultaneously so you pick the one that pays more.  In this case the 99291 will pay you 5.88 RVUs and the CPR code will pay you 4.91.

I hope that helps clear it up.

You can see much more in my free lectures on medical billing and coding.

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