Medical Billing For Cardioversion: External vs. Internal

by  Find-A-Code™
Jul 11th, 2023

Tachycardia and other abnormal heart rhythms can be converted to normal using a variety of therapies that include medications and electric shocks. Experienced medical billers and coders know that there are two primary CPT codes covering these therapies. They are 92960 and 92961. The codes apply to external and internal cardioversion. Do you know the difference?

Clinicians should not struggle with external vs. internal cardioversion. However, the notes they take may not necessarily be clear. Medical coders and billers need to know how to distinguish between the two procedures. Otherwise, prompt reimbursement cannot be guaranteed.

What Is External Cardioversion?

Conditions like atrial flutter and atrial fibrillation are normally treated with medications first. The right medications can often convert the abnormal rhythm back to a normal one. But if medication fails, external cardioversion using electric shock may be required. Patients are usually observed for several hours after treatment to make sure their rhythms remain normal.

External cardioversion is considered an elective procedure except in emergency situations. The hope is that the combination of medications and electric shock will restore an abnormal heart rhythm with the patient having no further problems.

As a side note, there is no CPT code for emergency external cardioversion. When an emergency requires the use of cardiac defibrillation, the 92950 CPT code for cardiopulmonary resuscitation is used.

What Is Internal Cardioversion?

When external cardioversion fails to restore normal atrial rhythm to an atrial fibrillation patient, internal cardioversion is the next step. As its name implies, internal cardioversion involves an invasive procedure through which medical devices are implanted with the assistance of fluoroscopy.

How doctors perform internal cardioversion affects which CPT codes are used. It also affects whether certain procedures are reported separately or together. For example, a planned procedure involving implantation of an internal defibrillator is not reported separately. Both the implantation and cardioversion are reported as a single incident.

Attention to Detail Is Critical

Although the differences between external and internal cardioversion seem simple enough from the practitioner's standpoint, attention to detail is still critical within the billing spectrum. Coders and billers need to be careful to assign the right codes based on clinician notes and visit records.

Medical billing for cardioversion can be confusing when clinician notes are not clear. Accurate billing requires careful attention to detail, beginning with verifying a patient's insurance at the start of the visit. Verification ensures that a patient's insurance coverage is active, up-to-date, and appropriate in terms of covering the procedure. Some insurance companies require pre-authorization before the cardioversion can be performed.

Generating Cardioversion Claims

Following a cardioversion procedure, coders and billers work together to generate a claim for services rendered. The claim includes details of the procedure, including:

• the date and time it was performed
• the type of procedure performed
• additional treatments or medications administered
• the provider's fees for the procedures and services rendered

Coding and billing for cardioversion can be complicated by several factors. For example, if a patient has multiple insurance policies, determining which policy is responsible for payment is not necessarily the easiest task. Moreover, a patient whose insurance plan has a high deductible may be required to pay a significant portion of the fee at the time of service.

To avoid confusion and errors, healthcare providers increasingly rely on specialized medical billing software, capable of reducing errors by automating many of the tasks involved in submitting claims and tracking payments. Automated software can also help ensure cardioversion claims meet all the necessary requirements for payment. That's the way to all but guarantee that reimbursement for rendered services is prompt.