ED Coding and Reimbursement Alert

Question: How would you code the following scenario? A78 year-old-male presents to the ED after suffering cardiac arrest. The medics had regained vital signs initially in route to the hospital but upon entering the ED, the patient "codes". The initial rhythm is noted to be ventricular fibrillation. The patient is defibrillated several times with escalating levels of electricity, and upon the 3rd attempt converts to normal sinus rhythm. At this point, the patient is intubated and rushed to the cardiac cath lab.

Answer: Sounds like you have defibrillation rather than cardioversion. According to the AMA CPT® Assistant, "Although cardioversion and defibrillation are both ways of shocking the heart to alter its rhythm, they are two distinctly different procedures. Defibrillation is the delivery of an electrical impulse to the heart. This impulse is intended to interrupt abnormal rhythms (e.g., ventricular fibrillation) and allow the normal sinus impulse and electrical conduction to resume."

There is no CPT® code to use to report defibrillation as a procedure performed in isolation. Code 92960 (Cardioversion, elective, electrical conversion of arrhythmia; external) is not used to report defibrillation performed as an emergency measure during the treatment of cardiac arrest or ventricular fibrillation.

There are situations where 92960 is reportable when there is an electrical conversion of a patient's arrhythmia in the ED. The chart should reflect that the patient's condition and the procedure have been explained to the patient and that they have consented to the procedure.

This is an example of a cardioversion note:

68 year-old-male status post CABG presents in A fib with rapid response and a heart rate of 170. Blood pressure is 90 and the patient is experiencing chest pain. Due to the hemodynamic compromise the decision is made to cardiovert rather than attempt the use of medications which could lower his blood pressure further. A small dose of valium is provided for sedation and the patient is cardioverted with 50 joules, after which his rhythm is restored to normal sinus.