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CPT Ref Guide

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Cardiovascular Services and Procedures restoring circulation (eg, closed-chest cardiac mas- sage). Advanced life support interventions such as drug therapy (eg, administration of lidocaine, atrophine, etc) should be reported with the critical care code(s) (99291-99292, 99466-99467, 99468-99476) from the Evaluation and Management (E/M) section of the Current Procedural Terminology (CPT® ) codebook. When advanced life support interventions and CPR are performed at the same session, code 92950 should be reported in addition to code 99291 or 99292, or code 99466, 99467, or 99468-99476. Therefore, based on CPT coding guidelines, cardio- pulmonary resuscitation is reported separately from critical care services, but the time spent performing CPR is not counted toward determining total critical care time. Code 92950 is reported for the 30 minutes of CPR performed. The critical care codes 99291 and 99292 or codes 99466-99467 would be reported for the remaining 90 minutes of critical care time. The time spent performing CPR is subtracted from the total critical care time as CPR was provided during the hour(s) of critical care services. Documentation in the patient’s record should indicate that the critical care time does not include the time spent performing CPR (30 minutes). TEMPORARY TRANSCUTANEOUS PACING 92953 Temporary transcutaneous pacing CPT Assistant Nov 99:49, Feb 07:10, Jul 07:1 109 Plans for temporary transvenous pacemaker insertion are made if appropriate. ELECTIVE CARDIOVERSION 92960 Cardioversion, elective, electrical conversion of arrhythmia; external CPT Assistant Summer 93:13, Nov 99:49, Jun 00:5, Nov 00:9, Jul 01:11; CPT Changes: An Insider’s View 2000 92961 internal (separate procedure) CPT Assistant Summer 93:13, Nov 99:49, Jun 00:5, Jul 00:5, Nov 00:9; CPT Changes: An Insider’s View 2000 Intent and Use of Code92960 Code 92960 describes elective external cardiover- sion. This service should be reported as an isolated procedure and not in the context of critical care or when it is an integral part of a procedure such as an electrophysiology study or coronary artery bypass graft (CABG) surgery. Intent and Use of Code92953 Code 92953 is used to treat clinically significant bradycardia. It is particularly useful as a bridge to trans- venous pacing or in the setting of acute hemodynamic deterioration caused by bradycardia. Code 99288 should be reported when temporary transcutaneous pacing is instituted by personnel out- side the hospital at the direction of the physician. Description of Service for Code92953 Transcutaneous pacing pads are applied to the patient’s anterior and posterior chest. Sedation is provided as needed, and the patient’s cardiac rhythm is monitored. Pacer output and rate are increased until the pace- maker overdrives the patient’s native heart rhythm. Hemodynamic stability with the paced rhythm is assessed, and additional sedation is provided as needed. Code 92960 specifically describes elective (non- emergency) external electrical cardioversion. Elective cardioversion is most often used to treat atrial fibril- lation and atrial flutter if antiarrhythmic 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 or her heart rhythm moni- tored for several hours after the procedure to ensure the rhythm remains stable. This procedure can be performed in an intensive care unit, a coronary care unit, emergency department, or in any room in an outpatient area that houses the nec- essary equipment (eg, cardiac monitor, crash cart). Questions are often raised regarding use of the cardio- version codes to report defibrillation. Defibrillation is the delivery of an electrical impulse to the heart. This impulse is intended to interrupt life-threatening abnor- mal rhythms (eg, ventricular fibrillation, pleiomorphic ventricular tachycardia, or ventricular tachycardia asso- ciated with shock) and allow the normal sinus impulse and electrical conduction to resume. The electrical impulse must be strong enough to cause depolarization (neutralization of the positive and negative electrical charges) of a large percentage of the myocardium. The CHAPTER 5

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