Electrical Cardioversion

Non-emergent, elective electrical cardioversion as intended by CPT code 92960 describes a synchronized, external cardioversion. Electrical cardioversion is used to treat arrhythmias if anti-arrhythmic drugs have failed to convert the rhythm to a normal sinus rhythm or if a patient is hemodynamically unstable.

As long as a patient can be given an explanation of the procedure and/or sign a consent form, the cardioversion is appropriately reported with CPT code 92960. The phrase “elective” cardioversion can feel off base in an emergency department, however the setting for the procedure is not material. The intent behind an elective cardioversion is that the procedure was not part of an emergency resuscitation and a form of verbal and/or written consent via explanation of the procedure is able to be obtained.

No, external electrical cardioversion (CPT code 92960) does not apply to defibrillation.

Defibrillation refers to asynchronized cardiac activity used to interrupt life-threatening, abnormal rhythms.

There is no CPT code to report defibrillation as defibrillation is NOT an isolated procedure. Defibrillation is a component of cardiac resuscitation and is not a separately reportable service.

CPT code 92960 should NOT be used to report defibrillation. However, patients requiring defibrillation would likely qualify for reporting CPR (CPT code 92950) and/or critical care (CPT code 99291-99292). See the CPR FAQ for details.

No, pharmacologic cardioversion refers to conversion of arrhythmias through use of intravenous drugs. It is included in the E&M service and is NOT a separately associated code or procedure. It cannot be billed separately and is associated with critical care time reported.

ECGs performed before or during cardioversion are inherent in the service described by code 92960 and should NOT be reported or billed separately.

If a post-cardioversion ECG is medically necessary, this ECG may be reported with a modifier 59 (Distinct Procedural Service). Your documentation must support the clinical reasoning and medical necessity (i.e., ST segment changes, diagnosis of unexpected underlying arrhythmia) to justify obtaining this study.

Yes. Refer to the ACEP Procedural Sedation FAQ for further details.

Yes, see ACEP Critical Care FAQ for further details. Time spent performing electrical cardioversion should not be included in the total critical care time reported.

Yes. CPT does not limit the use of procedural codes to whether or not a procedure is successful. It is important to determine whether the procedure was provided in its entirety. This is particularly true for elective cardioversion, where the procedure may be completed appropriately but the patient’s heartbeat may not convert to a regular rhythm.

If multiple shocks are made during the same cardioversion attempt, this is coded as a single 92960 code. However, if the patient later develops another arrhythmia requiring a separate, distinct cardioversion this is considered a second cardioversion attempt with an additional 92960 code and a modifier to indicate that this is a repeat procedure performed by the same physician (Modifier 51: Multiple Procedures).