Get a Charge out of Cardiology With Cardioversion and Defibrillation Tips

electrophysiology studies, physician documentation, pacemaker and ablation, cardiology coding

Cardioversions and defibrillations — they sound similar, and without crystal clear, specific physician documentation, often coders have a hard time telling which of these services has been performed in the emergency department. That’s why it’s a good idea to learn more about these procedures so you can code them properly, and thus get your facility and providers the payment they deserve.

First, Get Clear on Defibrillation

Cardioversion and defibrillation are distinctly different procedures. When providers perform defibrillation, it will always be an emergency procedure. Patients undergoing defibrillation typically have no pulse and are in ventricular fibrillation (I49.01), or pulseless ventricular tachycardia (I47.2). Defibrillation procedures use electric shock to restart or to normalize heart rhythms.

Here are some documentation clues that will help you understand whether your physician performed defibrillation, not cardioversion:

  • The physician delivers the shock at any point in the cardiac cycle
  • The physician gives no sedation because the patient is unconscious
  • A medical team gives CPR (92590)

Speaking of quick clues, CPR is a great way to quickly tell whether defibrillation was the procedure of choice. Did the medical team give CPR immediately before shocks were given? If CPR was ongoing, then defibrillation was probably the procedure given. It’s important to note that no CPT® code exists to report defibrillation as a procedure performed in isolation.

VF or VF? Same Abbreviation, Different Conditions

Watch out for the abbreviation VF; some providers use it to mean ventricular flutter (I49.02) and some use VF to mean ventricular fibrillation (I49.01). The conditions are significantly different: In ventricular flutter, the heart still beats but with a rapid heart rate that begins in the ventricles. In ventricular fibrillation the lower heart chambers move in rapid, uncoordinated contractions, jiggling, not beating. Ventricular flutter can degenerate into ventricular fibrillation, which can be fatal if not stopped. If your providers use abbreviations for these conditions, make sure they use ones that are not confusing, such as V-flut or v-flutter for ventricular flutter, and V Fib for ventricular fibrillation. Auditors seek clinical documentation that is clear and not confusing.

Getting a Clue About Cardioversion

Cardioversion is a process of converting one cardiac rhythm or electrical pattern to another, usually converting an abnormal cardiac rhythm to a normal one. Cardioversion can be chemical or pharmacologic, which means that it is given with a drug. If a pharmacologic cardioversion doesn’t work, then electrical cardioversion might be scheduled. In this procedure, doctors give patients a fast-acting anesthetic agent, then they deliver a brief, less than one second, electrical shock through two paddles to restore the regular heartbeat. The whole procedure takes about 30 minutes.

Here are some conditions that can be treated with cardioversion:

  • Atrial fibrillation (I48.91)
  • Atrial flutter (I48.92)
  • Paroxysmal supraventricular tachycardia (PSVT) (I47.1)
  • Paroxysmal tachycardia unspecified (I47.9)
  • Paroxysmal ventricular tachycardia (I47.2)

How About You?

Got any tips we missed for reporting these codes? Let us know in the comment box below.

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About 

Susan taught health information and healthcare documentation at the community college level for more than 20 years. She has a special love for medical language and terminology. She is passionate about ensuring accurate patient healthcare documentation through education. She has a master's degree in healthcare administration, is a certified healthcare documentation specialist, and serves as immediate past president for the Association for Healthcare Documentation Integrity (AHDI).

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