AHA Coding Clinic® for HCPCS - 2013 Issue 3; Ask the Editor

CPT code 92960 - emergent vs. elective

What does the term “elective” mean when reporting CPT code 92960, Cardioversion, elective, electrical conversion of arrhythmia; external, performed in the emergency department (ED). In an article published by the AMA “elective” is described as nonemergency. For example: How would this case be coded? A patient arrives by ambulance with complaint of his heart fluttering and beating fast and irregular. The patient states that he woke up around 2 a.m. with the sensation of fluttering on his upper back that lasted approximately 1 hour. He denies nausea, vomiting, dizziness, lightheadedness or chest pain. However, he is short of breath and has palpitations. The paramedics were called and the patient was transported to the ED. He appeared to be in atrial fibrillation with rapid ventricular response with a rate about 120. His blood pressure was 100 systolic range. He felt a little weaker than normal and stated that he saw a cardiologist a year ago and had a stress test performed at that time. The patient stated that he has been having palpitations associated with some shortness of breath (SOB) during the last 3 days. Two times in the past he had his atrial fibrillation converted to normal sinus rhythm (NSR) (1996 and 2002). He is currently on Sotalol, atorvastatin, warfarin, acetylsalicylic acid (ASA) and omeprazole. He was given a digoxin injection 250 mcg by slow intravenous (IV) push shortly after arrival, with no response. At 8 a.m. he still had a heart rate 118, BP 90/53. In the ED, direct current cardioversion (DCCV) was performed with 200 joules synchronized moder. Methohexital was used for sedation. Patient converted to NSR on the second attempt. There were no complications during the procedure. Patient recovered in the ER and was discharged home with instructions to follow-up with his cardiologist in 10 days.  ...

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