Cardiology Coding Alert

Answer: Most procedures are not coded on the basis of whether they were successful, says Kathleen Mueller, RN, CPC, CCS-P, an independent coding and reimbursement specialist in Lenzburg, Ill. The key is whether the procedure was completed.

If the elective cardioversion was performed and completed regardless of whether the patients heartbeat was converted to a regular rhythm 92960 (cardioversion, elective, electrical conversion of arrhythmia; external) should be reported without any modifiers appended. If, however, the cardioversion was attempted but had to be discontinued because of the patients condition, such as a reaction to anesthesia or respiratory distress, 92960 should be billed with modifier -53 (discontinued procedure) appended.

Mueller notes that successful conversions are often performed quickly, and physicians generally spend far more time unsuccessfully trying to convert a heartbeat. If you did everything you needed to do you used the proper techniques, administered medication, etc. and the patient still did not convert, the procedure should be considered complete.

Modifier -52 (reduced services) would not be appropriate in this situation because it implies that a service was performed to completion, albeit in a reduced fashion. If the cardiologist performed all the necessary steps for the cardioversion but was ultimately unsuccessful in converting the patients heartbeat, the service has not been reduced. Therefore, modifier -52 should not be appended, unless your carrier specifically instructs you (in writing) to do so.

Mueller notes that appending modifier -53 spurs an automatic carrier review, and therefore excellent documentation, indicating the time involved in the procedure and the cause of termination, is required