Cardiology Coding Alert

Watch the setting when choosing codes.

If your physician performed cardioversion, that service was either chemical or electrical. You can identify chemical cardioversion by sifting through the documentation.

A closer look: Chemical cardioversion, using an agent like adenosine, may be used to treat a patient with paroxysmal supraventricular tachycardia (PSVT) who is not considered unstable, says Michael A. Granovsky, MD, FACEP, CPC, President of Logix Health, a coding and billing company in Bedford, Mass. Although the patient isn’t hemodynamically unstable, he may have symptoms, including shortness of breath and hypotension, which is low blood pressure. The ICD-9 code for PSVT is 427.0 (Paroxysmal supraventricular tachycardia). The most direct match under ICD-10 is I47.1 (Supraventricular tachycardia).

Chemical cardioversion coding: According to CPT^® Assistant (November 2000), the answer to how to code depends on the services performed by the reporting provider. Possibilities include “prolonged services, critical care, evaluation and management services, or codes describing therapeutic or diagnostic infusion or injection procedures.” Remember that physicians don’t report infusions and supplies for services performed in the facility setting. The facility reports those.

Tip: There are certain services you may see in the medical record with chemical cardioversion. A physician will frequently attempt a vagal maneuver before giving a round of chemical cardioversion. If after chemical cardioversion the symptoms continue to progress or become severe, the case may warrant strong consideration of electrical cardioversion.

Electrical cardioversion: For more details on electrical cardioversion, see “Cardioversion: 92960 Won’t Fly for Emergency Defibrillation” in Cardiology Coding Alert, Vol.16, No. 6.