Electrical cardioversion is one of the most common procedures performed in cardiology and emergency medicine to restore normal sinus rhythm in patients with atrial fibrillation, atrial flutter, and certain supraventricular tachyarrhythmias. When a provider performs an elective synchronized cardioversion in a controlled setting, the correct CPT code is 92960.
Because cardioversion involves moderate sedation, direct current delivery, and careful monitoring, payers expect precise documentation, correct coding, and proper modifier use. CPT 92960 may seem straightforward, but errors in documentation and bundling are extremely common — especially when emergency departments, hospitals, and cardiologists share responsibilities.
This comprehensive guide covers everything your practice needs for accurate, compliant billing of CPT 92960: what it includes, when to use it, common mistakes, documentation requirements, modifiers, payer rules, ICD-10 pairing, and prior authorization considerations.
Strengthen your revenue cycle with the most detailed Cardiology Billing and Coding Guide covering E&M, procedures, imaging, stress testing, NCCI edits, and more.
What Is CPT 92960?
Official CPT description:
“Cardioversion, elective, electrical conversion of arrhythmia; external.”
In clinical terms:
CPT 92960 = Elective, synchronized external electrical cardioversion performed to treat an arrhythmia.
This is NOT defibrillation.
Cardioversion involves:
- Conscious/moderate sedation
- Synchronized energy delivery
- EKG monitoring
- Pre- and post-conversion evaluation
- Rhythm assessment after conversion
It is typically performed in:
- Cath lab
- EP lab
- ICU
- Emergency department
- Operating room
- Ambulatory surgical setting
What CPT 92960 Includes
When billing 92960, the following components are included and cannot be billed separately:
1. Synchronized External Shock(s)
Whether one or multiple shocks are delivered, they are still coded once.
2. Rhythm Monitoring
Continuous monitoring before, during, and after cardioversion.
3. Sedation Monitoring (But Not Sedation Itself)
Moderate sedation may be billed separately.
4. Procedure Preparation
Includes:
- Skin prep
- Electrode/paddle placement
- Selecting joule settings
- Arrhythmia identification
- Device setup
5. Post-procedure Rhythm Assessment
Determining if the sinus rhythm was restored. Ensure clean claims for cardiac monitor implants using our expert CPT 33285 Insertable Cardiac Monitor Implantation Billing Guide built for cardiology and electrophysiology practices.
6. Medical Decision-Making
Why was cardioversion chosen over rate control or medical conversion?
What CPT 92960 Does NOT Include
Some related services may be billed separately:
✔ Moderate Sedation
If the provider supervises sedation:
- 99152 (initial 15 minutes)
- 99153 (each additional 15 minutes)
✔ Transesophageal Echocardiogram (TEE)
When performed before cardioversion:
- 93312–93318 codes apply
✔ Emergency Department E/M Services
If separately identifiable and medically necessary.
✔ Anesthesia Services
If anesthesia handles sedation:
- Use anesthesia codes instead of 99152/99153.
✔ Repeat Cardioversion on Same Day
Possible with modifiers:
- 76 (same physician)
- 77 (different physician)
When to Use CPT 92960
CPT 92960 is appropriate for elective or semi-urgent cardioversion when:
1. Atrial Fibrillation (Most Common)
- Paroxysmal
- Persistent
- Symptomatic AF
- AF is refractory to medications
2. Atrial Flutter
- Typical counterclockwise flutter
- Atypical atrial flutter
3. Supraventricular Tachycardia (SVT)
When resistant to adenosine or medication.
4. Hemodynamically Stable Ventricular Tachycardia
If synchronized shock is used.
Reduce approval delays by reviewing our essential Cardiology Prior Authorization Guide with payer requirements, documentation templates, and workflow best practices.
5. Symptomatic Arrhythmias
With:
- Hypotension
- Shortness of breath
- Chest discomfort
- Syncope or presyncope
6. When Rapid Conversion Is Required
But the patient is stable enough for sedation.
When NOT to Use CPT 92960
Do not use 92960 in the following situations:
❌ Defibrillation for cardiac arrest
Use ACLS/critical care codes — NOT 92960.
❌ Chemical cardioversion only
Medication-only treatment → no CPT 92960.
❌ Implantable cardioverter-defibrillator (ICD) shocks
Use ICD interrogation codes (93282–93287), NOT 92960.
❌ Attempted cardioversion without electrical shock
Must use electricity to bill 92960.
❌ Cardioversion performed emergently without sedation in a crash scenario
These cases may fall under critical care billing.
Documentation Requirements for CPT 92960
To avoid denials, documentation must reflect the complete cardioversion workflow.
Required elements:
1. Indication for Cardioversion
Document symptoms such as:
- AF with RVR
- Decompensated heart failure
- Hypotension
- Severe palpitations
- Symptomatic SVT or flutter
Include failed attempts at rate control or chemical cardioversion when relevant.
2. Pre-Procedure Assessment
Must include:
- Pre-cardioversion rhythm
- Informed consent
- Airway & sedation plan
- Medication list, including anticoagulation status
3. Sedation Documentation
If billing 99152/99153:
- Start/stop sedation time
- Agent used (e.g., propofol, etomidate)
- Sedation depth
- Monitoring details
4. Procedure Description
Include:
- Electrode/paddle placement
- Energy delivered (e.g., 200J biphasic)
- Number of shocks
- Synchronized mode used
5. Post-Procedure Outcome
Document:
- Rhythm after cardioversion
- Complications (if any)
- Hemodynamic stability
6. Physician Signature
ICD-10 Codes Commonly Billed With CPT 92960
Some of the most frequent include:
- I48.0 – Paroxysmal atrial fibrillation
- I48.1 – Persistent atrial fibrillation
- I48.19 – Other persistent AF
- I48.21 – Permanent atrial fibrillation
- I48.3 – Typical atrial flutter
- I48.92 – Unspecified atrial flutter
- I47.1 – Supraventricular tachycardia
- I47.2 – Ventricular tachycardia (synchronized)
- R00.2 – Palpitations
- R07.9 – Chest pain
- I49.9 – Cardiac arrhythmia, unspecified
Typical Reimbursement for CPT 92960
Approximate Medicare averages:
- Facility reimbursement: $250–$350
- Physician fee: ~$125–$175
Commercial rates are often higher.
When billed with sedation and TEE (common scenario), reimbursement increases significantly. Protect your revenue by mastering denial patterns with our Cardiology Denials Playbook featuring high-risk codes, common payer triggers, and appeal strategies.
Prior Authorization Requirements
Medicare
- No PA required
Medicare Advantage
- PA is usually NOT required for cardioversion
- Rare exceptions → elective inpatient procedures
Commercial Payors
- Generally, NO prior authorization
- Some require PA if TEE is performed first
Medicaid
- Typically, no PA required
- Check state policy for TEE-first workflow
Correct Modifier Use With CPT 92960
Modifier 76 – Repeat Procedure by Same Physician
For additional attempts on the same day.
Modifier 77 – Repeat Procedure by Different Physician
If another provider performs a second cardioversion.
Modifier 59 – Distinct Procedural Service
Rarely used; typically not needed.
Modifier -22 (Increased Procedural Services)
Possible if:
- Extremely difficult cardioversion
- Multiple high-energy attempts
- Anatomical abnormalities
- Documentation must justify it.
Common Denials (and How to Prevent Them)
❌ 1. “Procedure Not Documented.”
Fix: Include shock, joules, rhythm before/after.
❌ 2. Sedation billed without proper times
Fix: Document exact start/stop times.
❌ 3. Missing medical necessity
Fix: Describe symptoms + arrhythmia findings.
❌ 4. Billed during defibrillation scenario
Fix: Clarify synchronized vs unsynchronized shock.
❌ 5. Cardioversion without sedation
If sedation is billed, documentation is essential.
❌ 6. Billed twice without a modifier
Use 76/77 when appropriate.
Final Thoughts
CPT 92960 is a straightforward but high-impact code in cardiology and emergency care. Because this procedure is performed frequently, accurate billing and consistent documentation are essential to avoiding denials and maintaining revenue integrity.
If your clinic, hospital, or cardiology group needs help improving cardioversion billing accuracy, reducing claim rejections, or optimizing sedation/TEE workflows, Global Tech Billing LLC specializes in cardiology RCM and can support your full billing cycle from start to finish.
Frequently Asked Questions (FAQ)
1. Can cardioversion be billed without sedation?
Yes, but sedation cannot be billed unless documented.
2. Can multiple shocks still be billed as one unit?
Yes — regardless of the number of shocks.
3. Can 92960 be billed in the ER?
Yes — as long as documentation supports the full procedure.
4. Does 92960 cover transesophageal guidance?
No — use TEE codes separately.
5. Can I bill an E/M visit with 92960?
Yes — if the E/M is distinct and medically necessary.
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