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Can both CPR and Critical Care or another E/M service be reported for the same patient encounter?

Yes, as long as the respective requirements for each service are satisfied and evident from the medical record. Both AMA and Medicare agree on this point.


CPR (CPT 92950) is a non-E/M service encompassing such activities as performing or supervising chest compression's, adequate ventilation of the patient (e.g., bag-valve-mask), etc.  As a separately re-portable service with Critical Care, the time spent providing CPR cannot be counted toward calculating total Critical Care time.

In contrast, Critical Care is an E/M service encompassing time spent in work directly related to care of the individual patient's critical illness/injury, whether that time was spent at the immediate bedside or elsewhere on the floor or unit.  For example, time spent on the unit or at the nursing station on the floor reviewing test results or imaging studies, discussing the critically ill patient's care with other medical staff or documenting critical care services in the medical record would be reported as critical care, even though it does not occur at the bedside.  


Also, when the patient is unable or clinically incompetent to participate in discussions, time spent on the floor or unit with family members or surrogate decision makers obtaining a medical history, reviewing the patient's condition or prognosis, or discussing treatment or limitation(s) of treatment may be reported as critical care, provided that the conversation bears directly on the management of the patient.

Critical Care is a time-dependent E/M service.  If the minimum total time requirement is not satisfied and/or documented, then an appropriate other E/M code should be reported.  Of course, any site of service, and key components (i.e., History, Physical Examination, and Medical Decision Making), etc. criteria for such alternative E/M will have to be satisfied and documented.

Some payers require that a -25 modifier be appended to the Critical Care E/M or alternative E/M code in order to indicate that it is a separately identifiable E/M service.


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