Cardioversion CPT Code

Cardioversion CPT Code (2022) Description, Guidelines, Reimbursement, Modifiers & Examples

Cardioversion CPT code(s) 92960 or 92961 bills for service when the physician performs elective cardioversion and electrical conversion of arrhythmia externally or internally. The physician delivers an electrical charge into the heart muscles to stimulate the heartbeat to a different rhythm.

Cardioversion CPT Code Description

The following are the reasons why the physician performs cardioversion:

Atrial fibrillation

Atrial flutter

Ventricular fibrillation

Ventricular tachycardia

Atrial tachycardia

The physician gives an electric shock to the patient’s chest to regulate heartbeats considered dangerously irregular. The electric shock machine consists of two paddles and a defibrillator machine placed by the physician on the patient’s chest or back. 

The determined electric shock administers from the chest to the heart to convert the heartbeat to a regular rhythm. Cardioversion CPT code 92960 bills for external cardioversion, and CPT 92961 when the procedure performs internally.

The following are the types of cardioversions:

Electrical Cardioversion: The Physician delivers an electrical shock to the patient’s chest with the help of paddles composed of electrode patches. Suppose the heart is not functioning correctly and is at higher risk of dangerous arrhythmias. The physician may implant an implantable cardioverter-defibrillator (ICD) to stabilize the patient’s heart rhythm. 

Chemical cardioversion: The Physician administers medicine or substance via IV route or swallowed by the patient directly. Correct heart rhythms may take several hours, minutes, or days.  

CPT 92960

Cardioversion CPT code 92960 bills for service when the physician externally performs elective cardioversion and electrical conversion of arrhythmia.

cpt code for cardioversion

CPT 92961

Cardioversion CPT code 92961 bills for service when the physician internally performs elective cardioversion and electrical conversion of arrhythmia.

cpt code for tee with cardioversion

Cardioversion CPT Code Reimbursement

A maximum of Two units can be a bill on the same service date of Cardioversion CPT code(s) 92960 and 92961. In contrast, the three units allow documentation supporting the service’s medical necessity. 

The cost and RUVS of CPT 92960 are $117.68 and 3.40048 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 92960 are $176.23 and 5.09248 when performed in the non-facility.

The cost and RUVS of CPT 92961 are $260.21 and 7.51929 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 92961 are $260.21 and 7.51929 when performed in the non-facility.

Cardioversion CPT Code Modifiers  

The following are the list modifiers applicable with cardioversion CPT code(s) 92960 and 92961: 

22, 23, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 80, 81 82, 99, , AS, CC, CR, ET, EY, GA, GC, GK, GR, GU, GY, GZ, KX, Q5, Q6, QJ, SG, TC, XR, XP, XU, XS, AI, AQ, AR. 

Modifier 47 applies to CPT 92960 and 92961 when the surgeon administers general or regional anesthesia to the patient. It is not appropriate to report modifier 47 with anesthesia procedures.

Modifier 76 is appropriate with CPT 92960 and 92961 when a similar service performs by the Same Physician on the same service date. 

Modifier 54 is applicable with CPT 92960 and 92961 when the physician provides surgical care only. In contrast, Modifiers 55 and 56 attach to CPT 92960 and 92961 when the physician performs post-management and preoperative care only. 

Modifier 76 is applicable with CPT 92960 and 92961 when a similar service performs by a different Physician on the same service date. 

Modifier 59 is applicable with CPT 92960 and 92961 when a Distinct service performs by the physician and bundled with another procedure on the same date.   

Modifier X {E, P, S, U} is applicable instead of Modifier 59 with CPT 92960 and 92961  when service bills to medicare insurance. It divides the modifier into four parts for further specification of the procedure. 

Modifier 53 will be reported with CPT 92960 and 92961  if an unsuccessful attempt makes due to unavoidable circumstances like allergic reactions to the substance. 

Modifier 22 applies to CPT 92960 and 92961 when services perform longer than usual and take extra resources during the procedure. 

Modifier 23 is applicable with CPT 92960 and 92961 when general or local anesthesia administers by the physician and routinely does not require during the procedure. 

Modifier 52 applies when the physician does not complete the immunization service and terminates due to unavoidable circumstances. 

If physicians believe that Medicare will deny such service, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), CPT 92960, and 92961 must apply the GA modifier to that service.

Cardioversion CPT Code Billing Guidelines

Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate.  

The following are ICD 10 Payable Dx codes when cardioversion CPT code(s) 92960 and 92961 bills: 

I44.0, I44.1, I44.2, I44.30, I44.39, I44.4, I44.5, I44.60, I44.69, I44.7, I45.0, I45.10, I45.19, I45.2, I45.3, I45.4, I45.5, I45.6, I45.81, I45.89, I45.9, I47.0, I47.1, I47.2, I47.9, I48.0, I48.11, I48.19, I48.20, I48.21, I48.3, I48.4, I48.91,I48.92, I49.01, I49.02, I49.1m I49.2, I49.3, I49.40, I49.49, I49.5, I49.8,and I49.9.

Suppose Device evaluation for implantable defibrillator/multi-lead pacemaker system (93282-93284, 93287, 93289, 93295-93296) performs with CPT 92960, or 92961. In that case, It is appropriate to report separately. 

Electrophysiological studies (93618-93624, 93631, 93640-93642) perform in conjunction with CPT 92960, or 92961. It is appropriate to report separately. 

If Intracardiac ablation (93650-93657, 93662) performs in conjunction with CPT 92960, or 92961, It is appropriate to report separately. 

Cardioversion CPT Code Examples

The following are the examples when cardioversion CPT code(s) 92960 or 92961 bills:

Example 1

A 38-year-old male presents to ED with a chief complaint of dizziness. The patient reports vertigo began one day ago. Vertigo began while at home when he stood up. 

The patient describes the course of vertigo as abrupt, and The dizziness is currently 6/10. Vertigo worsened by standing, head movement, and movement. The vertigo is not worsened by breathing or lying supine. 

Anti-vertigo meds alleviate vertigo. Vertigo is associated with nausea, vomiting, and gait instability. Vertigo is not associated with a vision change. 

The patient is morbidly obese ha a higher risk of heart disease. The PhysicianPhysician ordered multiple diagnostic tests ECG, CMP, CBC, CT, MRI, and X-ray of the head and spine.

Diagnostic studies show that patient had an irregular heartbeat and suggested cardioversion.

Example 2

A 30-year-old female with no PMH is coming in for intermittent episodes of chest pain exacerbated by left-arm movement but is non-exertional. 

Differential includes, but is not limited to MSK-related pain/costochondritis/ ACS Pt is very well appearing with routine physical exam and vitals. She is not having any pain right now. Given the positional nature of chest pain, I suspect a musculoskeletal cause. 

The patient was not getting better by medication. Physicians ordered a CT chest and EKG to confirm that the heart was functioning correctly. 

Diagnostic studies show that patient had an irregular heartbeat and suggested cardioversion.

Example 3

Forty-six-year-old female with PMH of hypertension and a family history of heart disease heart murmur, LBBB dx 1 year ago, migraines, tested positive for COVID 1 month ago. 

Since yesterday afternoon, she has presented to ED c/o constant lip-tingling, lightheadedness, and left-sided chest discomfort. She woke morning with the same symptoms, and she also developed left upper extremity tingling and bilateral hand tingling. The patient did not get vaccinated for COVID. 

The patient Denies headache, shortness of breath, back pain, abdominal pain, nausea, vomiting, diarrhea, changes in vision, urinary complaints, or any other symptoms. 

The patient has a family history of heart diseases—the physician plan to do labs, EKG, X-ray, CT, and MRI of the chest.

Diagnostic studies show that patient had an irregular heartbeat and suggested a Holter monitor for 24 hours.

Example 4

A 27-year-old male with PMH Systolic/Diastolic CHF (EF <15% 7/23/21, s/p AICD), COVID x2, s/p TAVR, CAD, CKD, PAD, hypothyroidism for shortness of breath. He has developed progressively worsening shortness of breath for four days. 

He noticed worsening SOB laying on his right side and with exertion. He takes his vitals daily and weighs himself daily. 

He typically weighs 171lbs but has seen a 3.5lb increase in his weight to 174.5lbs over this past week, which prompted him to take one dose of alprazolam 30mg. He noticed a minimal improvement in his symptoms with the alprazolam. 

When he has episodes of coughing with phlegm, he notices a substernal discomfort. The discomfort is not alleviated with rest and not exacerbated with exertion. He has also noticed increasing yellow phlegm production, cough, nasal congestion, and rhinorrhea. 

The physician has respiratory problems along with Heart issues. Diagnostic studies show that patient had an irregular heartbeat and suggested cardioversion. The physician ordered EKG, Labs, CT, and MRI to diagnose for further treatment.

Example 5

A 39-year-old female presented office for dizziness, weakness, and tingling in the upper extremity. The patient denies any abdominal pain, diarrhea, vomiting, or headache in the system review. 

Physical exam revealed that the patient had an irregular heartbeat, shortness of breath, and fluid accumulation in the upper extremity, more likely edema. A physical exam strongly suggests ruling out heart-related diseases. The physician decides to do ECG/EKG, CTA, and MRA of the chest. 

Diagnostic studies show that patient had an irregular heartbeat and suggested cardioversion. EKG revealed that the patient is tachycardic. The physician has consulted with the cardiologist for further treatment of the patient.

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