ED Coding and Reimbursement Alert

Question: How should I code an emergency-room visit for a child with known Wolff-Parkinson-White (WPW) syndrome who presents with supraventricular tachycardia (SVT) to 260 bpm that is converted to sinus rhythm by administration of adenosine? Is this chemical cardioversion billable?

Illinois Subscriber
 
 
Answer: Although chemical cardioversion is used to treat arrhythmia commonly caused by WPW, CPT does not recognize it as a procedure for this purpose. Electrical cardioversion (92960, electrical conversion of arrhythmia) is recognized by CPT and might on occasion be performed in the ED to treat a WPW patient suffering from arrhythmia. Using medication such as adenosine to stabilize an arrhythmia is not a separately billable procedure unless you report it with the IV-infusion codes 90782 (therapeutic, prophylactic or diagnostic injection [adenosine]; subcutaneous or intramuscular), 90783 (... intra-arterial) or 90784 (... intravenous).
 
If the documentation for this service supports 99285 (emergency department visit for the evaluation and management of a patient, which requires a comprehensive history, a comprehensive examination, and medical decision-making of high complexity), the use of adenosine would be bundled into the visit code for Medicare patients. Some private payers, however, might accept an IV-infusion code for this service.
 
Note: It is preferable to inject this type of medication rather than infuse it because it is administered in a very rapid bolus. It is not given as an infusion over time.
 
If the chart reflects imminent jeopardy of deterioration (such as low oxygen-saturation levels, poor capillary refill, or decreased peripheral pulses) and 30 minutes of total care was provided, 99291 (critical care, evaluation and management of the critically injured patient) might also be acceptable. If the child was unstable and/or met the definition for critical care but it took less than 30 minutes to get the patient into the room, hook up the monitor, perform the EKG and give the adenosine, the case would not qualify as critical care. But, if the time exceeds 30 minutes because of routine care, including checking the labs, bedside reassessments and talking to the patients primary care physicians, it might qualify as critical care.