Cardioversion—whether electrical or chemical—is a common but highly scrutinized service in cardiology billing. Even though the procedure codes appear straightforward, auditors frequently find errors involving medical necessity, same-day bundling issues, inadequate documentation, incorrect modifier use, and facility vs professional component confusion.
This guide provides a comprehensive, practical, real-world explanation of how to correctly bill, document, and code elective, emergent, and procedural cardioversions in hospitals, offices, and outpatient facilities.
Understanding the Two Cardioversion CPT Codes
CPT 92960 – Electrical Cardioversion
Defined as:
External electrical conversion of arrhythmia; elective, synchronized cardioversion.
Key points:
- Applies to synchronized shock delivered to convert atrial fibrillation, atrial flutter, SVT, or other tachyarrhythmias.
- Includes pre-procedural assessment, procedure-related sedation supervision, and post-procedure monitoring.
- It is a professional service code (no TC/26 split).
Common settings billed with CPT 92960:
- Hospital inpatient
- Hospital outpatient
- Office (if equipment available and meets safety standards)
- Ambulatory surgical center (ASC)
CPT 92961 – Internal Cardioversion
Defined as:
Internal cardioversion by transvenous or intracardiac catheters.
Key points:
- Often performed during EP studies or ablations.
- In most cases, bundled into comprehensive EP procedures (e.g., 93653–93656) unless documented for a separately identifiable purpose.
- Not commonly billed on its own due to bundling rules.
Internal cardioversion is considered a higher-risk procedure, requiring full documentation of intracardiac catheters, energy delivery, and the clinical rationale for internal shocks.
When Cardioversion Is Billable Separately
(High Audit-Relevance)
Auditors frequently deny cardioversion because it was:
- performed during another procedure,
- part of the routine EP workflow, or
- provided without medically necessary documentation.
Cardioversion is separately billable when:
1. The service is distinct from other procedures
Examples:
- A patient is scheduled for a TEE, and AF is discovered → electrical cardioversion added.
- Cardioversion is performed in the ED due to a new-onset symptomatic arrhythmia.
2. The cardioversion was clinically necessary and documented as such
Documented symptoms may include:
- Hypotension
- Chest pain
- Syncope or presyncope
- Severe shortness of breath
- Persistent AF causing hemodynamic instability
3. The cardioversion was NOT bundled into another service
This is especially relevant in EP procedures:
- Cardioversion during EP mapping is bundled.
- Cardioversion after AF ablation to assess PV isolation is bundled.
- Cardioversion during VT ablation is bundled.
4. When sedation is managed by another provider
Sedation is bundled into 92960 if the cardiologist administers or supervises it.
If anesthesia is provided by anesthesia staff, they bill their own CPT codes (99152–99153 or 00170 equivalents, depending on payer).
When Cardioversion Is NOT Separately Billable
(Frequently Missed)
Cardioversion cannot be billed separately when:
1. It is part of an ablation procedure
Most ablation procedures include cardioversion when required:
- 93653 (SVT ablation)
- 93654 (VT ablation)
- 93656 (AF ablation)
Cardioversion during these procedures is considered integral to the treatment.
2. It is performed as part of an EP study
Internal cardioversion is often used to induce arrhythmias or evaluate conduction patterns—it is not separately billable.
3. Cardioversion is performed for anesthesia recovery
Example: transient arrhythmia due to sedative effect.
4. It is performed during cardiac surgery
Bundled into the surgery global package.
Documentation Requirements for 92960 & 92961
(Absolutely Essential for Payment)
The procedure note MUST contain the following elements:
Pre-Procedure Documentation
- Indication for cardioversion
- Presenting arrhythmia (AF, AFL, SVT, VT)
- Duration of arrhythmia, if known
- Prior rate/rhythm control attempts
- Hemodynamic status (BP, HR, symptoms)
- Confirmation of anticoagulation status or TEE rule-out of thrombus (if elective)
Sedation Documentation
Must state:
- Who administered or supervised
- Sedation depth (minimal/moderate/deep)
- Medications used and doses
- Start/stop times
- Monitoring performed
(Sedation is bundled for the cardiologist but required for compliance.)
Procedure Description
Must include:
- Electrode placement
- Synchronization confirmation
- Energy levels used (e.g., 100J, 200J biphasic)
- Number of shocks
- Rhythm changes
- Final rhythm post-procedure
- Any complications
Post-Procedure Monitoring
- Cardiovascular response
- Oxygenation
- Consciousness
- Hemodynamic stability
- Disposition
Outcome Documentation
Examples:
- “Successfully cardioverted to NSR following 200J synchronized biphasic shock.”
- “Conversion unsuccessful after 3 attempts.”
Place of Service (POS) Considerations
SettingAllowed CPTKey Rules
Hospital Inpatient 92960, 92961 Bill professional only; hospital bills facility fee.
Hospital Outpatient 92960, 92961 Same as inpatient; list POS 22.
Office 92960 only (typically) Must have safe equipment + documentation of monitoring capability.
ASC 92960 (rare) Some payers restrict payment; verify coverage.
Emergency Department 92960 Always allowed when medically necessary.
| Setting | Allowed CPT | Key Rules |
| Hospital Inpatient | 92960, 92961 | Bill professional only; hospital bills facility fee. |
| Hospital Outpatient | 92960, 92961 | Same as inpatient; list POS 22. |
| Office | 92960 only (typically) | Must have safe equipment + documentation of monitoring capability. |
| ASC | 92960 (rare) | Some payers restrict payment; verify coverage. |
| Emergency Department | 92960 | Always allowed when medically necessary. |
92961 (internal) is rarely performed outside EP labs.
Modifier Use With Cardioversion
Modifier 25 – Significant, Separately Identifiable E/M
Used when:
- A same-day E/M is medically necessary,
- AND evaluation is not routine pre-procedural care.
Example:
- Patient presents with palpitations → full workup → decision for cardioversion → E/M 99285-25 + 92960.
Modifier 59 / XS – Distinct Procedural Service
Rarely used with cardioversion, except when:
- Performed at a separate encounter the same day as another procedure.
Modifiers 76/77 – Repeat Procedure
Used when:
- The patient requires cardioversion twice on the same day.
76 = same provider
77 = different provider
Modifier 22 – Increased Procedural Services
Used rarely, but may apply when:
- Multiple shocks
- Extensive resuscitative measures
- Extremely unstable patient
- Documentation must clearly describe extra time, work, and intensity.
Medical Necessity Triggers & Denial Prevention
Payers closely scrutinize cardioversion claims. The most common denial reasons include:
1. Insufficient documentation of symptomatic arrhythmia
Simply stating “Atrial fibrillation” is not enough.
Payers expect:
- Symptom description
- Hemodynamic impact
- Failed medical attempts
- Duration of arrhythmia
2. No documentation of synchronized shock
This is required for 92960.
3. Cardioversion bundled into another service
The most common denial for 92961 during EP studies or ablations.
4. No documentation of sedation supervision
Even though sedation is bundled, its documentation is a compliance requirement.
5. Incorrect billing of failed cardioversion
Even when unsuccessful, cardioversion is billable if all procedural steps were performed and documented.
6. Billing in the global period of a surgery without a modifier
Use:
- 24 for unrelated E/M
- 79 for unrelated procedure
- 78 if returned to the procedural room for complication-related arrhythmia management
Practical Billing Examples
Example 1: Successful Cardioversion in ED
- Full evaluation performed
- 200J shock → return to NSR
- Bill: 99285-25 + 92960
Example 2: Cardioversion during AF ablation
Do NOT bill 92960 or 92961
Bundled into 93656.
Example 3: Two shocks throughout the day (same provider)
Bill:
92960 + 92960-76
Example 4: Cardioversion after failed rate control
Bill: 92960 (if electrical)
Example 5: Internal cardioversion during EP study
Not separately billable unless documented as independent from the EP study purpose.
Documentation Template (Physician-Friendly)
Indication:
Patient with symptomatic atrial fibrillation presenting with [symptoms]. Hemodynamically [stable/unstable]. Failed [rate/rhythm control therapy].
Pre-Procedure:
Confirmed anticoagulation status. Monitoring established. Sedation administered: [meds/doses]. Synchronized mode verified.
Procedure:
Shock 1: [Energy].
Shock 2: [Energy].
Electrode placement: [details].
Conversion: [yes/no].
Post-Procedure:
Patient monitored for [time]. Rhythm: [NSR or other]. No complications noted.
Conclusion
Correctly billing CPT 92960 and 92961 requires a clear understanding of bundling rules, medical necessity criteria, documentation requirements, sedation expectations, and modifier usage. Missteps often lead to denials or audit risk—particularly when cardioversion is performed during EP or cath lab procedures. A structured approach to documentation and internal auditing ensures accuracy and compliance. Practices seeking assistance with cardioversion billing workflows, EP integration, and denial management often partner with experienced cardiology-focused RCM firms such as Global Tech Billing LLC.
FAQs
1. What is the difference between CPT 92960 and 92961?
92960 is for elective external cardioversion, while 92961 is for internal cardioversion performed using intracardiac electrodes.
2. Is sedation included in CPT 92960?
Yes. Moderate sedation is typically included, and should not be billed separately unless payer policy allows anesthesia services under specific conditions.
3. Can you bill an E/M visit on the same day as cardioversion?
Yes, but only if the visit is significant, separately identifiable, and unrelated to the procedure. Append modifier 25.
4. Does cardioversion have a global period?
No. Both CPT 92960 and 92961 have 0-day global periods, meaning follow-up visits are generally billable.
5. Can CPT 92960 be billed in the ED or inpatient setting?
Yes, but documentation must specify the reason for cardioversion, rhythm type, attempts, energy delivered, and immediate response.
6. What documentation is required for cardioversion?
Required elements include: rhythm pre- and post-procedure, number of shocks, energy level, sedation administered, patient response, and complications (if any).
7. Is cardioversion bundled with EP ablation or cardiac catheterization?
If performed to restore rhythm during another cardiac procedure, it is usually bundled. Only bill separately if performed as a distinct, medically necessary service.
8. What diagnosis codes support medical necessity for cardioversion?
Common ICD-10 codes include I48.0–I48.92 (atrial fibrillation/flutter), I47.1 (SVT), and rhythm-related instability codes when appropriate.
