Cardiology Coding Alert

Reader Question:

Chemical Cardioversion

Reviewed on May 22, 2015

Question: How do we code chemical cardioversion? The chemical used was 2 mg of ibutilide in two aliquots each infused over a 10-minute period. We know we can’t bill 92960 (cardioversion, elective, electrical conversion of arrhythmia, external). But we’ve tried 90782 (therapeutic or diagnostic injection) and it was denied. Then we tried 90780 (IV infusion for therapy/diagnosis) but Medicare stated that it is Part A and denied it as well.
Sandi Poor

Answer: Pharmacologic, or chemical cardioversion, is a relatively new procedure that usually takes place in the acute care setting, rather than at the office. If that is the case, the American College of Cardiology (ACC) advises that you can’t bill for the infusion therapy itself, because it is considered a facility -- not a physician charge which is included in the codes below:

99354-99357, prolonged physician service
99291-99292, critical care
99231-99233, subsequent hospital

However, if the chemical conversion takes place in the physician’s office, you can use code
If the infusion took place in the office, use a push code such as 96374 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; intravenous push, single or initial substance/drug) for this 10 minute service.

In addition to using the infusion code, you’ll also need to report the name and dosage of the drug using the HCPCS level II code as appropriate.

Also, you should code, based on the physician’s documentation, the appropriate level of evaluation and management service for the office visit, 99201-99215.

CPT® deleted 90782 in 2006.