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Cardioversion and Defibrillation Tips

By Susan Dooley

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. Thats why its 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.

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

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. Its 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 doesnt 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)

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

How About You?

Got any tips we missed for reporting these codes? Let us know.

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Name: Sam Nair
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Email: shyamn@codinginstitute.com
Direct: 704 303 8150

Desk: 866 228 9252, Ext: 4813

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com