Identifying services from the clinical chart is problematic even for
emergency coding veterans. The problem gets accentuated when it comes to
cardioversions and defibrillations as these emergency codes
get used interchangeably along with added complication of identifying
"chemical" or "electrical" cardioversions. Any slips in identifying the
right procedure results in wrong emergency coding and hence leading to
claim denials.
The problem lies in distinguishing each procedure, before assigning emergency code for them. After discerning the proper procedure, emergency code can be recorded and that will help in securing the deserved payments. For identifying the procedure and emergency code, it is important to examine the documentation carefully to look for clues about the procedure.
Step 1 Identifying in between cardioversion and defibrillation
In order to identify defribillation, one must understand the procedure, what it entails and the tell tale signs. One must begin by recognizing defibrillation which is an electric shock given to patient to normalize heart rhythm and it is an emergency procedure. According to Michael A. Granovsky (MD, FACEP, CPC), President of LoxigHealth, some more indicators for defibrillations in the documentation are (1) delivering electrical shock at any point in the cardiac cycle (2) unconscious patient (3) pulse less cardiac rythms. A very simple method to identify defibrillation is to check whether CPR was ongoing immediately before the shocks were delivered.
There are a few distinct clues in order to identify cardioversion. The objective of cardioversion is to convert one cardiac rhythm to another or electrical rhythm i.e. to convert from abnormal rhythm to normal rhythm.
You can then allocate the right emergency code as per the identification made.
Step 2 Identify in between Chemical or Electrical Cardioversion
In cardioversion, physician can either perform chemical or electrical. A chemical cardioversion is given to patients who are not considered unstable i.e. they are not hemodynamically unstable. For responding to symptoms like shortness of breath, or low blood pressure, chemical cardioversion procedure is used. But if these symptoms become severe or progressing, electrical cardioversion procedure is used by the physician. Emergency department patients who are unresponsive to drugs being used in chemical cardioversion may be given electrical cardioversion. Typically, electrical cardioversion is among the urgent procedures.
Elective electrical cardioversion means that patients consent is taken in the ED before the procedure is initiated. The procedure is for patients who are stable but their condition is expected to deteriorate quickly. n order to identify whether the procedure was elective electrical cardioversion, one must sift through the complete documentation as there will be substantial proof of ER Physician taking consent from the patient for performing the procedure as well as communicating to patient the benefits as well as complication which may result from the due procedure. There is divided opinion among experts as some experts believe elective cardioversion to be a scheduled procedure while others believe that it does not necessarily be a scheduled procedure. Since there is no clear cut resolution, it is better to ask the physician to make specific documentation describing the procedure as elective or not.
Documentation is integral to make the right choice of emergency code. There are also consistent coding changes which pose further challenges. One can also refer to AMA CPT Assistant which helps you keep track of all coding changes. CPT Assistant also answers many difficult questions, provides references and much more.
The problem lies in distinguishing each procedure, before assigning emergency code for them. After discerning the proper procedure, emergency code can be recorded and that will help in securing the deserved payments. For identifying the procedure and emergency code, it is important to examine the documentation carefully to look for clues about the procedure.
Step 1 Identifying in between cardioversion and defibrillation
In order to identify defribillation, one must understand the procedure, what it entails and the tell tale signs. One must begin by recognizing defibrillation which is an electric shock given to patient to normalize heart rhythm and it is an emergency procedure. According to Michael A. Granovsky (MD, FACEP, CPC), President of LoxigHealth, some more indicators for defibrillations in the documentation are (1) delivering electrical shock at any point in the cardiac cycle (2) unconscious patient (3) pulse less cardiac rythms. A very simple method to identify defibrillation is to check whether CPR was ongoing immediately before the shocks were delivered.
There are a few distinct clues in order to identify cardioversion. The objective of cardioversion is to convert one cardiac rhythm to another or electrical rhythm i.e. to convert from abnormal rhythm to normal rhythm.
You can then allocate the right emergency code as per the identification made.
Step 2 Identify in between Chemical or Electrical Cardioversion
In cardioversion, physician can either perform chemical or electrical. A chemical cardioversion is given to patients who are not considered unstable i.e. they are not hemodynamically unstable. For responding to symptoms like shortness of breath, or low blood pressure, chemical cardioversion procedure is used. But if these symptoms become severe or progressing, electrical cardioversion procedure is used by the physician. Emergency department patients who are unresponsive to drugs being used in chemical cardioversion may be given electrical cardioversion. Typically, electrical cardioversion is among the urgent procedures.
Elective electrical cardioversion means that patients consent is taken in the ED before the procedure is initiated. The procedure is for patients who are stable but their condition is expected to deteriorate quickly. n order to identify whether the procedure was elective electrical cardioversion, one must sift through the complete documentation as there will be substantial proof of ER Physician taking consent from the patient for performing the procedure as well as communicating to patient the benefits as well as complication which may result from the due procedure. There is divided opinion among experts as some experts believe elective cardioversion to be a scheduled procedure while others believe that it does not necessarily be a scheduled procedure. Since there is no clear cut resolution, it is better to ask the physician to make specific documentation describing the procedure as elective or not.
Documentation is integral to make the right choice of emergency code. There are also consistent coding changes which pose further challenges. One can also refer to AMA CPT Assistant which helps you keep track of all coding changes. CPT Assistant also answers many difficult questions, provides references and much more.
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