CPR is performed when the patient’s heart and lungs suddenly stop. CPR involves the provision of cardiac life support including chest compressions and ventilation of the patient. CPT states 92950 is intended to describe CPR 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 (e.g., mouth-to-mouth, bag-valve-mask, etc.), and restoring circulation (e.g., closed chest cardiac massage).
The physician does not have to physically perform the chest compressions or ventilation of the patient, but rather can direct the provision of CPR services. According to the AMA “From a coding perspective, indeed the physician may report 92950 whether he/she is actually performing compressions or ventilation or directing these activities while other staff is actually performing cardiopulmonary resuscitation.”
ACLS involves the provision of drug therapy and possibly defibrillation and these services are reported with the appropriate E/M service, such as 9928X or critical care (99291). CPT states, “In most instances, CPR is performed prior to, with continuation during, advanced life support interventions, e.g., drug therapy and defibrillation, which would be included by reporting the appropriate critical care services code(s) from the E/M section of the CPT codebook.”
ACLS does not always require CPR and CPR requires some form of chest compressions and sometimes ventilation that are not a direct component of ACLS.
No. CPT lists no minimum or maximum amount of time spent performing and/or supervising CPR as being required to report CPR.
Yes, as long as the respective requirements for each service are satisfied and evident from the medical record. Both CPT and Medicare agree on this point.
CPR is a non-E/M service encompassing such activities as supervising or performing chest compressions, adequate ventilation of the patient (e.g., bag-valve-mask), etc. CPT does not list a typical time to qualify for providing CPR. As a separately reportable service with Critical Care, the time spent providing CPR cannot be counted toward calculating total Critical Care time.
See ACEP Critical Care FAQ for further details.
According to the AMA “Cardiopulmonary resuscitation” was deleted as an inclusive service of the Critical Care services codes at the June 1992 CPT Editorial Panel meeting for CPT 1993. Therefore, since January 1, 1993, it has, and currently remains, appropriate for the physician to report CPR (code 92950) in addition to the Critical Care Service code(s).”
Following an episode of CPR, if a patient regains vital signs and care meeting the definition of Critical Care was provided for at least 30 minutes, then it would be appropriate to report CPR and Critical Care services. Similarly, if a patient were to receive Critical Care services and then subsequently require CPR it would be appropriate to report both services. However, if the patient received Critical Care for less than 30 minutes outside of the CPR time, then CPR and an E/M level such as 9928X should be reported.
If the patient encounter does not satisfy Critical Care requirements, the E/M level of service (e.g., 9928X) should be determined by the extent of the 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. (See ACEP FAQ Evaluation and Management Documentation Requirements CMS vs. CPT #8 for a discussion about Acuity caveats). The E/M level should be proportional to the amount of work performed determining the patient’s history, the extent of the physical exam, and the degree of medical decision making while CPR is being performed.
Yes. The emergency physician must document a procedure note just like he/she would with any other procedure. It is also possible to report CPR together with a subsequent hospital visit or critical care if the respective E/M performance, time, and documentation requirements are met.
There are no specifically defined documentation criteria for reporting CPR listed in CPT. Providers should be aware of the need to demonstrate medical necessity and the services provided. A procedure note stating that CPR was performed may be part of a hospital wide uniform “code sheet.”
Yes. Other procedures such as intubations, central lines, etc. can be reported in addition to CPR.
In some circumstances and/or for some payers, practitioners may need to indicate that a given episode of CPR and other services are in fact mutually separate and distinct. In such instances, the -25 modifier (appended to E/M services) is usually utilized to distinguish a non-E/M service from E/M services (e.g., Critical Care, ED E/M, etc.) and the -59 modifier is utilized to distinguish one non-E/M service from other non-E/M services (e.g., Intubation, endotracheal, emergency procedure; etc.).
Updated March 2021
The American College of Emergency Physicians (ACEP) has developed the Reimbursement & Coding FAQs and Pearls for informational purposes only. The FAQs and Pearls have been developed by sources knowledgeable in their fields, reviewed by a committee, and are intended to describe current coding practice. However, ACEP cannot guarantee that the information contained in the FAQs and Pearls is in every respect accurate, complete, or up to date.
The FAQs and Pearls are provided "as is" without warranty of any kind, either express or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. Payment policies can vary from payer to payer. ACEP, its committee members, authors or editors assume no responsibility for, and expressly disclaim liability for, damages of any kind arising out of or relating to any use, non-use, interpretation of, or reliance on information contained or not contained in the FAQs and Pearls. In no event shall ACEP be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Specific coding or payment related issues should be directed to the payer.
For information about this FAQ/Pearl, or to provide feedback, please contact David A. McKenzie, ACEP Reimbursement Director at (469) 499-0133 or email@example.com.