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    Health Service Code 13.99E

    Resuscitation, per 15 minutes or major portion thereof

    NOTE:
    1. Resuscitation is defined as the emergency treatment of an unstable patient whose condition may result in imminent mortality without such intervention.
    2. May be claimed when this service follows a consultation or hospital visit earlier in the same day as defined under GR 1.19.
    3. When the condition of the patient is such that further care is provided, either before or after the patient is resuscitated, at a level consistent with the description of HSC 13.99H, 13.99HA, 13.99J, 13.99K, 13.99KA or 13.99KB, time spent providing that care may be claimed using these HSCs. Concurrent claims for overlapping time for the same or different patients may not be claimed.
    4. If two claims for HSC 13.99E at different encounters are submitted by the same or different physician, text is required.
    5. Two physicians may not claim HSC 13.99E for concurrent care. The second and subsequent physician involved in the resuscitation may claim HSC 13.99EC.
    Category:M Minor Procedure
    Base rate:$96.52

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    CALLM151 - 15For Each Call Pay Base At100%
    SURCEVYesIncrease By$48.70
    SURCNTAMYesIncrease By$116.83
    SURCNTPMYesIncrease By$116.83
    SURCWKYesIncrease By$48.70
    LVPLVP75YesReduce Base To75%

    Governing Rules:

    • 6.1

      If a physician performs a minor procedure and provides a service warranting a claim for an office visit or a home visit on the same day, benefits for both may be claimed only if the services and diagnoses are unrelated.

    • 6.2

      If a service is provided in a hospital emergency department, AACC or UCC, only the minor procedure or the visit benefit, whichever is the greater, may be claimed, unless the problems are emergencies and the diagnoses are unrelated.

    • 6.7.1

      If a minor procedure (M or M+) is provided with a hospital visit on the same day, only the greater benefit HSC may be claimed.