Medical Billing for Cardioversion

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Medical Billing for Cardioversion
Basics of Cardioversion Cardioversion is a
medical procedure by which an abnormally fast
heart rate (tachycardia) or other cardiac
arrhythmia is converted to a normal rhythm using
electricity or drugs. For medical billing
purposes, cardioversion has been coded as an
external and internal procedure. CPT codes 92960
(cardioversion, elective, electrical conversion
of arrhythmia external) and 92961
(cardioversion, elective, electrical conversion
of arrhythmia internal separate procedure) are
used to report cardioversion. As the CPT code
description mentions, code 92960 specifically
describes elective i.e., non-emergency external
electrical cardioversion while CPT code 92961 is
used to report the internal cardioversion. To get
accurately reimbursed lets understand medical
billing for cardioversion. External
Cardioversion Elective or external cardioversion
is most often used to treat atrial fibrillation
and atrial flutter if anti-arrhythmic drugs fail
to convert the heart back to normal sinus rhythm,
or if the patient is hemodynamically unstable.
The electric shock given in cardioversion is
synchronized i.e., timed to occur during the R
wave of the electrocardiogram. The patient will
have his rhythm monitored for several hours after
the procedure to ensure the rhythm remains stable.
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Medical Billing for Cardioversion

• Internal Cardioversion
• Internal cardioversion is most commonly used to
  convert atrial fibrillation to normal sinus
  rhythm when external cardioversion is
  unsuccessful. Internal cardioversion requires
  vascular access, placement of catheters into the
  heart under fluoroscopic guidance, and much
  greater knowledge of electrophysiology
  procedures.
• Medical Billing for Cardioversion
• CPT code 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.
• There is a specific CPT code, 92960, for
  cardioversions. There are no separate codes or
  modifiers for using paddles or hands-free, and
  there are no special codes or modifiers for
  biphasic cardioversion. CPT code 92960 is for an
  elective cardioversion, not defibrillation. There
  is no separate code for defibrillation.
  Defibrillation is incorporated into CPR, which
  has its own CPT code (92950). Therefore, it is
  important to use the correct terminology in your
  charting to demonstrate you are cardioverting the
  patient and not defibrillating the patient.

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Medical Billing for Cardioversion

• To charge 92960 the cardiologist must have
  informed consent from the patient he or she must
  discuss the risks and get a signed consent form
  before performing elective cardioversion. For
  example, 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.
• There is no CPT code to report emergency cardiac
  defibrillation. It is included in cardiopulmonary
  resuscitation (CPT code 92950). If emergency
  cardiac defibrillation without cardiopulmonary
  resuscitation is performed in the emergency
  department or critical/intensive care unit, the
  cardiac defibrillation service is not separately
  reportable. Providers/suppliers shall not report
  CPT code 92960 for emergency cardiac
  defibrillation. CPT code 92960 describes a
  planned elective procedure. If a planned elective
  external cardioversion is performed by a
  provider/supplier reporting critical care time
  (CPT codes 99291, and 99292), the time to perform
  the elective external cardioversion shall not be
  included in the critical care time.
• Since cardioversion includes interrogation and
  programming of an implantable defibrillator if
  performed, interrogation and programming of an
  implantable defibrillator system (e.g., CPT codes
  93282-93284, 93289, 93292, and 93295) shall not
  be reported separately with a cardioversion
  procedure (e.g., CPT codes 92960, 92961).

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Medical Billing for Cardioversion

• CPT code 92961 is not separately reportable with
  cardiac catheterization or percutaneous cardiac
  interventional procedure. CPT code 92961 is
  defined as a separate procedure,
  and CMS payment policy does not allow separate
  payment for a separate procedure performed with
  another procedure in an anatomically related
  region through similar access. Internal
  cardioversion, like a cardiac catheterization or
  a percutaneous cardiac interventional procedure,
  is performed using similar percutaneous vascular
  access and placement of one or more catheters
  into the heart under fluoroscopy. CPT codes for
  percutaneous vascular access, radiopaque dye
  injections, and fluoroscopic guidance shall not
  be reported separately.
• Cardiac catheterization, percutaneous coronary
  artery interventional procedures (angioplasty,
  atherectomy, or stenting), and internal
  cardioversion include insertion of a needle
  and/or catheter, infusion, fluoroscopy, and ECG
  rhythm strips (e.g., CPT codes 36000, 36140,
  36160, 36200-36248, 36410, 96360-96376, 76000,
  93040-93042). All these services are components
  of cardiac catheterization, percutaneous coronary
  artery interventional procedure, or internal
  cardioversion and are not separately reportable.
  Additionally, ultrasound guidance is not
  separately reportable with these procedures.
• Medical Billers and Coders (MBC) is a leading
  medical billing company providing complete
  revenue cycle management services. We shared
  medical billing for cardioversion so that
  providers will get accurately reimbursed for
  delivered services.

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Medical Billing for Cardioversion
We referred various source materials along with
the Medicare coding manual to discuss medical
billing for cardioversion in detail. If you need
any assistance in medical billing and coding for
your practice, email us at info_at_medicalbillersand
coders.com or call us at 888-357-3226.   CPT
Copyright 2022 American Medical
Association Reference Medicare NCCI 2022 Coding
Policy Manual Chapter 11