Trying to figure out why your claim was denied for an electrical cardioversion? Let’s simplify the requirements for CPT code 92960! Healthcare providers perform cardioversion to restore a patient’s normal heartbeat either via medication or an electrical shock. While the procedure may seem quite straightforward to you as a cardiologist, the billing process for it is anything but simple.
The main reasons? Coding confusion, documentation gaps, and payer-specific rules! We understand that even experienced coders struggle with deciding whether the 92960 CPT code should be billed as a standalone service or bundled with another cardiac procedure. That’s why today we will break down everything you need to know about electrical cardioversion coding so you can avoid costly mistakes.
CPT Code 92960 – Description
The description for this code is quite simple. Maintained by the American Medical Association (AMA) under ‘Therapeutic Cardiovascular Services and Procedures’, CPT code 92960 refers to an elective electrical cardioversion. Pay special attention to the word elective here! It means that the 92960 CPT code only covers a planned cardioversion at a hospital.
During an elective electrical cardioversion, a healthcare provider carefully places soft electrode pads on the patient’s chest or back to deliver a controlled electrical shock. They perform this procedure to restore a normal heart rhythm in patients with arrhythmia, improving their cardiac function and overall well-being.
Scenarios Where CPT Code 92960 is Applicable
Improve your coding accuracy with the following scenarios:
Elective Cardioversion for AFib
Atrial fibrillation (AFib) is more common than we think, affecting 10.5 million Americans (nearly 5% of the U.S. population). Many AFib patients with regular major symptoms choose cardioversion to correct their heartbeat.
So, for the first scenario, suppose a 65-year-old woman with atrial fibrillation is on antiarrhythmic drugs for some time. However, she continues to experience shortness of breath and irregular heartbeats. After a consultation with her cardiologist, she elects to undergo an electrical cardioversion.
The physician prescribes anti-clotting medicine and schedules the procedure in two weeks. Once the patient is admitted to the hospital, the cardiologist performs an electrical cardioversion and uses CPT code 92960 to bill for it.
Elective Cardioversion for Post-Operative AFib
Did you know that post-operative AFib is quite common? Unfortunately, it is also undertreated, leading to a higher risk of stroke, transient ischemic attack, and even death. According to a 2022 study published in Annals of Internal Medicine, 13% of 4,231 patients developed AFib within a week of non-cardiac surgery.
So, for this example, let’s envision something similar. Assume a 45-year-old man develops irregular heartbeats post-thoracic surgery. The main reasons? Stress and inflammation. The provider monitors the patient for two days and schedules an electrical cardioversion a day later. He performs the procedure under anesthesia and uses CPT code 92960 to report it.
Elective Cardioversion to Treat Atrial Flutter
Atrial flutter is another type of arrhythmia. It is similar to AFib but has a more organized and regular rhythm. Cardioversion is the most popular treatment for this disorder, successfully working for 70–90% of people.
Therefore, for the last example of CPT code 92960, consider a 56-year-old man with hypertension. He experiences heart palpitations, chest pain, and lightheadedness. Since his atrial flutter is unresponsive to medications, the cardiologist recommends an electrical cardioversion.
The patient is admitted to a hospital where the provider delivers a synchronized shock to correct his heart rhythm. His billing team then uses the 92960 CPT code to bill for the procedure.
Applicable Modifiers for CPT Code 92960
You can apply the following modifier with CPT code 92960:
Modifier 59
Was the cardioversion you performed distinct and separate from other services you provided on the same day to the same patient? For example, a patient had an irregular heartbeat during pre-operative evaluation. Therefore, you planned an electrical cardioversion before the operation. In this case, you can append modifier 59 with CPT code 92960.
Modifier 79
Did you perform an unrelated cardioversion during the post-operative period of a surgery? Apply modifier 79 to CPT code 92960 to indicate that it is not related to post-operative care.
CPT Code 92960 – Billing & Reimbursement Guidelines
Follow these billing and reimbursement guidelines for CPT code 92960 to receive complete payments:
Use CPT Code 92960 for Planned Electrical Cardioversion
Remember, this code only covers planned electrical cardioversion performed via an external defibrillator. Hence, you cannot use it to bill for an emergency intervention during a cardiac arrest. Moreover, avoid using the 92960 CPT code for chemical cardioversion, which uses medication to restore a heart’s rhythm.
Justify Medical Necessity
As usual, insurance payers will assess the medical necessity of this intervention based on your documentation. Therefore, make sure to include the following details in the patient’s record:
- Patient’s symptoms (e.g., irregular heartbeats, chest pain, dizziness)
- Clinical reason for performing the procedure (Afib, atrial flutter, or any other reason)
- Procedure details (synchronized electrical shock)
- Outcome
Apply Appropriate Modifiers
This code usually does not require modifiers. However, you can use modifier 59 or 79 with the 92960 CPT code if the cardioversion was distinct from other services or performed during an unrelated post-operative care period.
Verify Payer-Specific Rules & Requirements
Some insurers may bundle this code with other cardiac procedures. Therefore, verify their coverage requirements and NCCI edits before filing a claim for CPT code 92960.
Summary
Have you identified the reason for your denials? To summarize, CPT code 92960 refers to an electrical cardioversion. This intervention is usually planned and performed through an external defibrillator. Hence, you can use this code to report that you have delivered a synchronized electrical shock to restore a patient’s heart rhythms.
We have provided three detailed examples to help you understand its correct application. Moreover, you can follow our tips to file accurate claims for the 92960 CPT code. However, if you don’t want to code any service or procedure, hand over everything to an expert. Many billers offer cost-effective cardiology billing services to help you maximize your revenue.
