# should i bill 92950 or 92960



## bhargavi (Jun 3, 2015)

INDICATIONS FOR THE PROCEDURE   Acute anterior ST-segment elevation myocardial 
infarction.  The patient was brought into the catheter lab emergently.  Upon 
arrival to the cardiac catheter lab he had a ventricular fibrillation cardiac 
arrest.  Defibrillation was performed successfully.  He reverted back into 
severe sinus bradycardia with a long period of unresponsiveness however 
responded after.  Groins were prepped and draped in an aseptic technique and 
6-French sheath was inserted in the right femoral artery.  Diagnostic 
left-to-right coronary arteries were performed showing the following 
1.  The angiographically normal.                                                
2.  Left anterior descending is a large vessel.  Proximally it is fifty percent 
occluded before take off a large diagonal branch.  The diagonal has an area of 
80% stenosis.  The remainder of the left anterior descending has nonobstructive 
disease.
3.  The left circumflex artery is anatomically nondominant with mild 
nonobstructive disease.  It supplies only one obtuse marginal branch.  The 
right coronary artery is 100% occluded proximally.
Using a JR-4 guiding catheter an ATW marker wire was able to cross the 
occlusion of the right coronary artery.  It was predilated to 2.5 x 15 mm 
balloon followed by the insertion of the insertion of 3.5 x 23 mm Xience Alpine 
drug eluting stent and post dilated with 3.5 x 15 mm noncompliant balloon with 
excellent result and no residual stenosis.  Left heart catheterization with 
left ventricular angiogram  actually showed no wall motion abnormality with 
preserved ejection fraction of 15%.  Impression 
1.  Cardiac arrest in the setting of inferior ST elevation myocardial 
infarction.  This patient  was resuscitated with cardioversion.
2.  100 percent occlusion of the right coronary artery treated successfully 
with insertion of 3.5 at 23 mm Xience Alpine drug eluting stent.
3.  Preserved left ventricular function.                                        
4.  Fifty percent left anterior descending and 80% diagonal disease.    

my question is should i bill cpr with 93458/c9606 ?
thanks in advance


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## jdking (Jun 5, 2015)

*92960*

If there was no ventilation for the lungs done then would just use 92960 for the defibrillation, for your cath and sent. would use 92941-RC, 93458-51,59


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## rebec26@juno.com (Jun 5, 2015)

Cardioversion: 92960 Won't Fly for Emergency Defibrillation
- Published on Thu, May 09, 2013

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CPR and cardiac cycle synchronization offer key clues to proper coding.
Cardioversions and defibrillations can trigger claim denials if you don?t know how to distinguish between those services. With the added complication of the vaguely defined ?elective? cardioversion, it?s no wonder there is often confusion. 
Here are some guidelines to help you recognize each procedure so you?ll be on your way to securing proper reimbursement.
Separate Defibrillation From Cardioversion
Cardioversion is not the same thing as defibrillation, emphasizes Michael A. Granovsky, MD, FACEP, CPC, President of LogixHealth, a coding and billing company in Bedford, Mass.
Defibrillation, the use of an electric shock to restart or normalize heart rhythms, is always an emergency procedure, says Granovsky. The patient who receives this service has no pulse and is typically in ventricular fibrillation, or VF. The ICD-9 VF code is 427.41 (Ventricular fibrillation), and the ICD-10 code is I49.01 (Ventricular fibrillation). 
On occasion, physicians also render defibrillation for patients with ventricular tachycardia (VT) when the patient has no pulse, aka pulseless VT.  For documented VT, the ICD-9 code is 427.1 (Paroxysmal ventricular tachycardia). ICD-10 includes I47.2 (Ventricular tachycardia).
Defib clues: Below are additional clues that the procedure is defibrillation, according to Granovsky:
?         The physician delivers the shock at any point in the cardiac cycle
?         There is no sedation (the patient is unconscious)
?         A medical team also renders CPR (92950, Cardiopulmonary resuscitation [e.g., in cardiac arrest]).
Pay attention to this CPR detail. If CPR was in progress, then defibrillation shocks were likely given, not cardioversion, Granovsky says. 
Coding: There is no CPT? code to report defibrillation as a procedure performed in isolation. ?Defibrillation may be performed as part of critical care services, at the end of open heart surgery, during cardiac catheterization and coronary angiography, or during an electrophysiological procedure. Defibrillation is often a component of cardiac resuscitation, especially in adults. In all of these situations, defibrillation is not a separately reportable service,? states CPT? Assistant (November 2000).
Watch Cardiac Cycle Sync for Cardioversion Clue
In contrast to defibrillation, electrical cardioversion uses energy delivered in synchronization with the cardiac cycle to convert the heart back to normal sinus rhythm. Cardioversion treats a variety of conditions, including these: 


Coding: ?CPT? code 92960 [Cardioversion, elective, electrical conversion of arrhythmia, external] describes a planned elective procedure,? states the Correct Coding Initiative (CCI) manual, Chapter XI.I.3 (available from the Downloads section at www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html).
A physician may perform elective cardioversion for atrial fibrillation or atrial flutter if the heart doesn?t convert back to normal sinus rhythm following administration of anti-arrhythmic drugs or if the patient is hemodynamically unstable, Granovsky explains. Elective cardioversion usually entails fasting after midnight the day before and starting an intravenous line as preparatory work. The typical setting for elective cardioversion is in an Intensive Care Unit, a Coronary Unit, or other outpatient area with appropriate equipment, such as a cardiac monitor and crash cart, he adds, in line with information given as long ago as the Summer 1993 CPT? Assistant. 
Additionally, many experts see ?elective? as meaning the service isn?t required to immediately curtail an actively progressing deadly rhythm, which allows room for coding elective cardioversion that?s decided upon and performed on the same date. 
For instance: Suppose a patient presents with atrial fibrillation at a rate of 180. For this patient, there are other treatment options, generally involving drugs such as Cardizem first. However, if these pharmacologic interventions fail, the physician may decide to employ cardioversion, Granovsky explains, so selecting cardioversion may be ?elective? in this case. 
What to look for: Documentation to suggest that the treatment was elective cardioversion would include the physician obtaining informed consent from the patient and discussing the risks and benefits of the procedure, as well as the patient potentially receiving sedation to make the procedure more comfortable. These items paint the picture that this was an elective treatment even if it wasn?t pre-scheduled.
Do this: Ask your physician to document specifically if the cardioversion was elective, Granovsky instructs.


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## jenneverett (Jun 11, 2015)

I would code the 92941, for the acute MI intervention, (the cath is bundled into it...) 
92960 is elective cardioversion, so I would not use that.

I would not bill 92950 because chest compressions and breathing were not used...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.

Jennifer Everett, CPC


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