CPT code 92950,92953,92978,92979 -and allowable modifiers

Procedure Description

92950 Heart/lung resuscitation cpr – Average fee payment $322

+92978 Coronary vessel or graft imaging with IVUS or OCT, initial vessel

+92979 Coronary vessel or graft imaging with IVUS or OCT, each additional vessel

Global Surgery

• Critical Care should not be paid on the same calendar date the physician reports a procedure code with a global surgical period

• When critical care is billed with CPT modifier 25 the documentation must support both time and a service provided that is above pre-and/or post-operative care and associated with the procedure (applies to any procedure with 0, 10 or 90 day post-op period) – Only exceptions to this rule are CPR (CPT code 92950) and Insertion of Swanz-Ganz (CPT code 93503




REIMBURSEMENT GUIDELINES

Oxford reimburses Prolonged Services with Direct Patient Contact when reported with E/M codes in which time is a factor in determining level of service in accordance with CPT guidelines. Physicians or other health care professionals should report only Prolonged Services with Direct Patient Contact beyond the typical duration of the service on agiven date, even if the time spent by the physician or other care professional is not continuous. Providers should not include the time devoted to performing separately reportable services when determining the amount of prolonged services time. For example, the time devoted to performing cardiopulmonary resuscitation (CPT code 92950) should not be included in prolonged services time. A prolonged service of less than 30 minutes total duration on a given date is not separately reported because the work involved is included in the total work of the evaluation and management codes.


Q4. When determining critical care time, what can be included? For instance, cardio-pulmonary resuscitation (CPR), Procedure  code 92950, 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. Procedure  does not list a typical time to qualify for providing CPR.

A. The following services, when performed on the day a physician bills for critical care, are included in the critical care service and should not be reported separately:

• The interpretation of cardiac output measurements (Procedure  codes 93561, 93562);

• Chest x-rays, professional component (Procedure  codes 71010, 71015, 71020);

• Blood draw for specimen (Procedure  code 36415);

• Blood gases, and information data stored in computers (e.g., ECGs, blood pressures, hematologic data-Procedure  99090);

• Gastric intubation (Procedure  codes 43752, 91105);

• Pulse oximetry (Procedure  codes 94760, 94761, 94762);

• Temporary transcutaneous pacing (Procedure  92953);

• Ventilator management (Procedure  codes 94002-94004, 94660, 94662); and

• Vascular access procedures (Procedure  codes 36000, 36410, 36415, 36591, 36600).

No other procedure codes are bundled into the critical care services. Therefore, other medically necessary procedure codes may be billed separately.

Time involved performing procedures that are not bundled into critical care (i.e., billed and paid separately) may not be included and counted toward critical care time. The physician’s progress note(s) in the medical record should document that time involved in the performance of separately billable procedures was not counted toward critical care time.