Health Information Management

Q&A: How do we report ED defibrillation?

APCs Insider, October 31, 2014

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Q: We see a lot of patients in our ED who have to be defibrillated for a cardiac arrhythmia. Sometimes the physician performs it during CPR, but sometimes the physician catches it before the situation totally deteriorates. We have been reporting CPT® code 92960 (cardioversion, elective, electrical conversion of arrhythmia; external) in these situations; however, we just underwent an audit and the auditor said this was is incorrect. If it is incorrect, how do we report the procedure in the ED?
 
A: Defibrillation and cardioversion are similar but not the same. Both are used to correct a cardiac arrhythmia; however, no HCPCS code describes defibrillation. CPT code 92960 describes an elective cardioversion, which is a scheduled procedure that entails timing the low-voltage electric shock with the heart’s rhythm in order to deliver the shock at a precise moment. Cardioversion is used to treat arrhythmias such as atrial fibrillation. Sometimes the arrhythmia can be converted with medication.
 
On the other hand, defibrillation is a high-voltage shock given in an emergency situation when the arrhythmia occurs. Typically, these arrhythmias are immediately life-threatening and there is no organized heart rhythm, allowing the shock to be administered virtually at any time. The NCCI Manual, Chapter 11, notes:
 
3. There is no CPT code to report emergency cardiac defibrillation. It is included in cardiopulmonary resuscitation code 92950. If emergency cardiac defibrillation without cardiopulmonary resuscitation is performed in the emergency department or critical/intensive care unit, the cardiac defibrillation service is not separately reportable. Physicians should not report CPT code 92960 (cardioversion, elective...; external) for emergency cardiac defibrillation. CPT code 92960 describes a planned elective procedure. If a planned elective external cardioversion is performed by a physician reporting critical care time (CPT codes 99291, 99292), the time to perform elective external cardioversion should not be included in the critical care time.
 
The resources for defibrillation should be included in the charge for CPT code 92950 (cardiopulmonary resuscitation [e.g., in cardiac arrest]) or in the ED visit criteria. The resources can be counted only once, so ensure that if you report CPR, you do not also count it for purposes of assigning the ED visit level.
 
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Florida, answered this question.



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