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 let’s 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.

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.
• 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).
• 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. 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: [email protected] or call us at: 888-357-3226.

CPT Copyright 2022: American Medical Association

Reference: Medicare NCCI 2022 Coding Policy Manual – Chapter 11

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