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Basics of Cardioversion CPT code 92960 & 92661

Cardioversion has been coded as external and internal procedure in medical coding. CPT code 92960 and 92961 are used to report cardioversion . Elective or external cardioversion is most often used to treat atrial fibrillation and atrial flutter if anti-arrhythmic drugs fail to convert the heart back to normal sinus rhythm, or if the patient is hemodynamically unstable.

The electric shock given in cardioversion is synchronized (ie, timed to occur during the R wave of the electrocardiogram). The patient will have his/her heart rhythm monitored for several hours after the procedure to ensure the rhythm remains stable.

CPT Code 92960 specifically describes elective (nonemergency) external electrical cardioversion while CPT code 92961 is used to report the internal cardioversion.

Internal Cardioversion is most commonly used to convert atrial fibrillation to normal sinus rhythm when external cardioversion is unsuccessful. Internal cardioversion requires vascular access, placement of catheters into the heart under fluoroscopic guidance, and a much greater knowledge of electrophysiology procedures.

Elective external cardioversion (CPT code 92960) is performed to restore normal cardiac rhythm in patients who are experiencing an abnormally rapid heart rate (arrhythmia). Sedation is administered. Two defibrillator pads or paddles are used. One pad/paddle is placed on the patient’s chest near the sternum and the second is placed either in the lower left chest or on the back under the left scapula.

Electrical impulses (shocks) are delivered that restore normal cardiac rhythm. The strength of the electrical impulse depends on the type of arrhythmia and the patient’s response. If the first attempt to restore the heart to normal rhythm is unsuccessful, a higher electrical impulse may be used and the procedure repeated. Internal cardioversion (CPT code 92961) involves placing the defibrillator pads directly on the heart during open chest surgery. Electrical impulses (shocks) are delivered directly to the heart muscle.

Description of CPT code 92960 & 92961

92960 Cardioversion, elective, electrical conversion of arrhythmia; external

92961 internal (separate procedure)

In this procedure, the physician may administer an electronic shock to the patient’s chest to regulate heartbeats considered dangerously irregular. The physician uses a defibrillator machine and places two paddles on the patient’s chest and/or back. A measured electric shock is delivered through the chest to the heart to convert the heartbeat to a regular rhythm. CPT code 92960 is reported for external cardioversion and CPT code 92961 is reported when the procedure is performed internally.

Also remember, the setting does not determine whether this procedure is emergent or elective. As long as the patient can be given an explanation of the procedure and/or sign a consent, the cardioversion would be appropriately reported with CPT code 92960, Cardioversion, elective, electrical conversion of arrhythmia; external.

CPT Code 92961 is designated as a separate procedure. Internal elective cardioversion is not separately reported when performed as an integral component of another procedure/service as in an electrophysiological study or cardiac catheterization. However, if the internal elective cardioversion is performed independently, unrelated or distinct from other procedure(s)/service(s) provided at that time, then it would be appropriate to separately report the internal cardioversion.

As per the coding guidelines CPT code 92961 should not be reported with CPT code 93282-93284, 93287, 93289, 93295, 93296, 93618-93624, 93631, 93640-93642, 93650, 93653-93657, 93662.