Ask Dr. Z

Is it appropriate to bill for a pharmacological cardioversion? "Patient has a history of PAF with episode of SVT. Performed as outpatient in hospital setting. The patient had pads placed in the anterior and posterior positions. Patient had a good 18-gauge IV placed in the left antecubital. He was given 6 mg of adenosine IV. His baseline rhythm was junctional tachycardia with rate of approximately 106 bpm. He responded appropriately to the dose of adenosine but went right back into junctional tachycardia. He was given a 12 mg dose in the usual fashion but again went back into junctional tachycardia. I then gave him 5 mg of intravenous Lopressor, and he slowed down and then converted back in sinus rhythm with frequent PACs after that. He tolerated the procedure well." The physician planned for the patient to receive the "chemical" cardioversion.