What's code blue? It's a hospital term used to initiate ACLS protocols when someone's 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 way I handle this situation depends on how long I spend on the patient's care. Cardiac resuscitation has its own CPT® code: 92950. For a full review of all CPT® codes, review the AMA's CPT 2013 Standard Edition, the authority on CPT coding. The work RVUs for code blue are 3.79 RVUs. Remember RVUs are how 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 perform ACLS resuscitation on 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 ten minutes. Some codes take thirty minutes. Some codes take an hour. I get $175 no matter how much time I spend if I bill a 92950.
However, if I code the patient and they survive and I proceed to perform critical care, separate and independent of the actual code resuscitation, I bill critical care time (if my additional time was at least 30 minutes) using the critical care code CPT® 99291 and critical care add on code CPT® 99292 and I document that my critical care time was independent of my time involved in resuscitation during code blue.
If the patient codes a second time in the same day, I bill another CPR code 92950. And on and on and on. While this situation is rare, I am not aware of any problems getting paid for performing and submitting payment for more than one ACLS resuscitation in a calendar date.
How does payment for the critical care codes compare to payment for the CPR code and when should you use critical care codes instead of CPT® 92950? A 99291 code (the first 30-74 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. The CPR code pays 4.91 total RVUs as described above.
So here are some scenarios to consider:
- You code someone and it lasts less than 30 minutes and you do nothing else: Bill a CPT® 92950 (CPR code)
- 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 and make sure you document this critical care time was independent of your code blue time.
- 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 consider picking the code that pays more. In this case the 99291 will pay you 5.88 RVUs and the CPR code will pay you 4.91. And ACLS resuscitation is definitely within the boundaries of critical care.
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