ED Coding and Reimbursement Alert

Question: The definition of cardioversion 92960 reads in part, "elective, electrical conversion of arrhythmia; external." What does "elective" mean in this definition? And is 92960 included in critical care? Minnesota Subscriber Answer: The definition of "elective" for 92960 (Cardioversion, elective, electrical conversion of arrhythmia; external) is subject to debate. Some experts take it to mean a scheduled procedure. Others take it to mean that the cardioversion doesn't have to be done to save the patient's life.

Take defibrillation, for example, which is not elective. Apatient in ventricular fibrillation will die without defibrillation. But a patient with atrial fibrillation at a rate of 180 generally doesn't have to be cardioverted. The meaning of "elective" becomes complicated for the following scenario: Apatient in a life-threatening arrhythmia is unstable and needs cardioversion. Though the procedure is not defibrillation, it isn't elective cardioversion either. However, if you don't code the procedure as "elective," then there's no code for the service rendered.

Your documentation can help you. If the physician's documentation points toward "elective" status, then you can get your code cleared. "Elective" documentation might say, "Patient in a fib with rapid response. Will attempt to slow with Cardizem. If unsuccessful, plan cardioversion with sedation." If you have time to sedate the patient, you have further indication of an "elective" procedure. Your chart should indicate that the cardioversion was planned and prepared for. And no, this code is not bundled into critical care. You Be the Coder and Reader Questions reviewed by Mike Ganovsky, MD, CPC, CFO, of Greater Washington Emergency in suburban Maryland.