Administration of Emergent Shock Shouldnt Be Billed Alone
Published on Fri Sep 01, 2000
There is no code for defibrillation or cardioversion administered to patients in an emergency situation. The service is not supposed to be billed separately because it is considered part of the larger service that often accompanies it, such as cardiopulmonary resuscitation, emergency department (ED) evaluation and management (E/M) services, critical care services, cardiac catheterization, implantable-cardio defibrillator (ICD) implantation, other electrophysiological procedures or at the end of open heart surgery.
The presence of a code for elective cardioversion, however, as well as the proliferation of a variety of incorrect theories about how to bill the service and get it paid, has perplexed many cardiology coders. Their confusion likely is increased by authoritative coding advice that incorrectly contrasts only defibrillation as emergent and cardioversion as always elective.
When the Service Is Performed
An individual may require emergent electric shock if he or she experiences episodes of ventricular fibrillation (VF) or ventricular tachycardia (VT). In addition, patients with supraventricular tachycardia (SVT) or atrial fibrillation (AF) also may require emergent electric shock.
Patients with VF require defibrillation, which involves the delivery of an electrical impulse to the heart to interrupt abnormal rhythms and allow normal sinus impulse and electrical conduction to resume. On the other hand, patients with VT require cardioversion, in which the electrical shock that is administered is synchronized to an ECG. Patients with SVT or AF also require synchronized shock (i.e., cardioversion).
The defibrillation for VF and the cardioversion for the VT, SVT or AF that is performed emergently contrasts significantly with elective cardioversion, which may be performed to treat AF and atrial flutter on a planned basis, possibly after the failure of anti-arrhythmic drugs to convert the patient chemically.
In this procedure (92960, cardioversion, elective, electrical conversion of arrhythmia; external), the patient is given either a sedative or anesthetic, after which one or more synchronized electric shocks are administered and the patients heart is monitored to ensure that the rhythm has stabilized.
The difference between the two services is emphasized in an article in the summer 1993 edition of CPT Assistant, published by the American Medical Association (AMA), which also created and maintains the CPT system. The article contrasts elective cardioversion only with emergent defibrillation and doesnt mention emergent cardioversion. In addition, part of the description of the elective cardioversion procedure if the patient is hemodynamically unstable actually describes emergency cardioversion.
Coders may be confused about how to code the delivery of a synchronized emergent shock (commonly referred to as cardioversion not defibrillation) to hemodynamically unstable patients, or those with VT, SVT or AF. Consequently, coders may use (incorrectly) the nearest code available, i.e., 92960.
Note: Internal cardioversion (92961) also is an elective procedure typically performed on patients who require [...]
