Cardiology Coding Alert

Question: We've been submitting 99223 for outpatient hospital services (POS 22), but Medicare rejected the claims for invalid place of service. What is the correct code? What if there is another service, such as cardioversion (92960), on the same date? Do we need to use a modifier?

Codify Member

Answer: You should code outpatient hospital visits using the appropriate office/outpatient code, depending on the documentation (such as 99201-99215, Office or other outpatient visit ...). That should match outpatient place of service (POS) 22.

You may be able to report 92960 (Cardioversion, elective, electrical conversion of arrhythmia; external) for elective cardioversion with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the E/M, depending on documentation.

Code 92960 has global period 000 in the Medicare Physician Fee Schedule. That means payment for 92960 includes same-day pre- and post-operative E/M services related to the cardioversion. As a result, you should not report E/M codes for services related to the cardioversion.

Also keep in mind 92960 reimbursement includes the pre- and post-cardioversion ECGs so you should not code those separately. The pre ECG verifies the patient continues to have an abnormal rhythm, and the post ECG verifies the cardioversion was successful. In some cases, the patient converts to normal sinus rhythm before the elective cardioversion is performed, causing a cancellation of the elective cardioversion. When this occurs, the appropriate E/M and initial EKG identifying the normal sinus rhythm should be documented and charged.

99223: You should not report 99223 (Initial hospital care, per day, for the evaluation and management of a patient ...) for an outpatient service. Save that code for the first inpatient service the physician provides to the patient.