Cardioversion Denials Raising Your Blood Pressure? Find Out Where Youre Going Wrong
Published on Tue Jul 01, 2003
If you're not clear on what separates cardioversion from defibrillation, let alone what separates one cardioversion from another, you will never receive payment for you physician's work.
Accurately identify these procedures in the ED by focusing on individual, clinical details and do this before you even think about coding. (For more on the codes for these procedures, refer to "How to Capture Pay for Cardioversions, Defibrillations".)
Cardioversions and defibrillations solicit denials when coders don't adequately understand the physician's notes and accurately distinguish between these two pacing procedures. Often, they're reported interchangeably or not at all. Throw in the added complication of "chemical" versus "electrical" cardioversions and the elusive "elective" cardioversion, and you have confusion that's bound to muddle claims.
But if you learn to distinguish between each procedure, coding them is easy, and you will secure payment, even if it's minimal experts will tell you how. Look for Documentation Hints to Separate Defib From Cardio First things first: Cardioversion is not the same thing as defibrillation, says Robert La Fleur, MD, president of Medical Management Specialists in Grand Rapids, Mich., so you shouldn't report them the same way.
Defibrillation, when physicians use carefully controlled electric shock to restart or normalize heart rhythms, is always an emergency procedure, says Norma Herzog, CCS-P, NREMPT-P, the compliance manager at Med-Data Inc. in Seattle. The patient who receives this service has no pulse and is in ventricular fibrillation (VF) (427.41), she says. A physician will sometimes defibrillate a patient in apparent asystole (427.5) because the rhythm may be a fine VF, and you have nothing to lose in trying the procedure, she adds.
On occasion, physicians also use defibrillation for patients with ventricular tachycardia when the patient has no pulse (427.1), La Fleur says, but most often for defibrillation, "These patients are dying."
The following clues in the documentation may also indicate that the physician performed defibrillation, Herzog says:
the physician delivers the shock at any point in the cardiac cycle (the synch mode on the machine is turned off, La Fleur says)
there is no sedation (the patient is almost always unconscious)
a medical team also renders cardiopulmonary resuscitation (CPR) (92590) (there are pulseless cardiac rhythms).
Pay attention to this CPR detail. The shortcut way to know whether your physician performed defibrillation and didn't perform cardioversion is to check for indications that medical personnel also performed CPR. If CPR was in progress, the physician most likely gave defibrillation shocks, Herzog says. Break Down Cardio Into Chemical and Electrical Contrary to defibrillation, cardioversion [...]
