ED Coding and Reimbursement Alert

Once you've distinguished between cardioversions and defibrillations, chemical and electrical, elective and emergency then the coding comes easily, but with minimal reward.

 Some money, however, is better than no money, so squeeze out what change you can from these crucial procedures.
 
The downside with reporting cardioversions and defibrillations for the ED is that most of them don't have specific CPT codes. (To find out more about how to identify cardioversions and defibrillation, read "Cardioversion Denials Raising Your Blood Pressure? Find Out Where You're Going Wrong".)
 
If the physician performs defibrillation, that work is bundled into cardiopulmonary resuscitation (CPR), says Norma Herzog, CCS-P, NREMPT-P, the compliance manager at Med-Data Inc. in Seattle.
 
Robert La Fleur, MD, president of Medical Management Specialists in Grand Rapids, Mich., says that as far as he knows, no payers separately reimburse defibrillation and there's no separate CPT code. Hopefully, the AMA will assign a code for this procedure, given that it is "one of the most important and riskiest procedures in emergency medicine," La Fleur says. For now, you shouldn't separately report it.
 
You can't separately rake in money for cardioversions either, at least not for those that are emergent. CPT has a cardioversion code only for elective, electrical cardioversion, Herzog says, but ED physicians usually render emergency not elective cardioversions. You should include that work for emergency cardioversions in the appropriate E/M service (99281-99285) or critical care (99291-99292).
 
You will find no specific codes for elective chemical conversion either, La Fleur says. You could try, using a therapeutic IV injection code, for example 90784. In this instance, the physician should be at the bedside when the drug is given. 

If applicable, you can report the occasional ED elective, electrical cardioversion (92960) again when documented as such, though this conceivable situation is uncommon. If the ED physician provided critical care, subtract out from critical care time the time spent rendering elective cardioversion. Any time spent in concurrent procedures for the patient does not count as critical care time.