Cardiology Coding Alert

Question: On page 2 of the article Emergency Department Coding for Cardiology Practices in the January issue, you stated one may code 92960 (cardioversion, elective) with critical care. Since 92960 is an elective cardioversion, it should not be reported with critical care. Our practice has not found a code for emergency defibrillation unless complete CPR is done.

Sandy Fuller, Coder
Cardiology Consultants, Abilene, TX

Answer: You are correct. There is no code for defibrillation alone. For example, chapter 4 of the 1998 edition of the American College of Cardiology Guide to CPT also states 92950 (complete cardiopulmonary resuscitation service) can be billed if it was provided as an isolated event, but not as part of cardiopulmonary resuscitation in a critical care setting.

It also states that 92960 (elective cardioversion) should be reported as an isolated procedure and not in the context of critical care or when it is an integral part of a procedure such as an electrophysiology study or coronary artery bypass.

As the reader pointed out in a follow-up interview, to charge 92960 the cardiologist must have informed consent from the patienthe or she must discuss the risks and get a signed consent form before performing elective cardioversion.

For instance, the example above would be an appropriate use of 92960: A patient with myocardial infarction and atrial fibrillation comes in for a cardiac cath. The cardiologist explained that the cath and the cardioversion would be performed during the same session. The patient agreed, and signed the consent form. Therefore, the 92960 could be billed.