Health Information Management

Q/A: Can we report cardioversion performed during an ED code?

APCs Insider, February 15, 2013

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Q: We’ve just completed our yearly audit and the ED portion was pretty good.  We did agree with one item. The auditor said that we should not be reporting CPT® code 92960 (cardioversion, elective, electrical conversion of arrhythmia; external) for the defibrillation that is done in our ED during a code.  When the patient is shocked to restart his/her heart, we charge for the cardioversion because that is what the clinicans are doing – converting the patient’s rhythm.  Could you help us defend this?

A:  A cardioversion does involve converting the patient’s heart rhythm, but the delivery of the shock is timed with the patient’s heart rhythm to deliver at the appropriate time to reset the rhythm. 
Defibrillation is an electrical shock, but it does not have to be timed to the rhythm, because many times the patient does not have a sustained heart rhythm when defibrillation is required.  Defibrillation is performed in response to a heart that is not beating – it is quivering and not functioning as a heart should.  This is included in cardiopulmonary resuscitation (CPR) and not separately reportable.  The National Correct Coding Initiative manual, chapter 11, provides the following instruction:
There is no CPT code to report emergency cardiac defibrillation. It is included in cardiopulmonary resuscitation (CPT 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 the elective external cardioversion should not be included in the critical care time.
In this scenario, the auditor is correct.  Educate staff, especially in the ED, so everyone knows how to appropriately report the service.
Editor’s note: Andrea Clark, RHIA, CCS, CPCH, chairman, CEO, and founder of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.

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