# Moderate Sedation-My doc sometimes



## dmrussell (Dec 22, 2010)

My doc sometimes uses moderate sedation on some of his patient that are getting injections, and questioned about if he does it by way of IV, 99144 should be used and has a question about the description: 

99143-Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patients level of consciousness and physiological status: younger that 5 years of age, first 30 minutes intra-service time.

We use 99144 because all of our patients are adults in a pain management office.  So his question is: who is considered a trained observer?  Does this mean a PA or RN or can a CMA be considered.

I have searched for this on the internet with no finding.

Hope someone can help with this...Thanks


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## dwaldman (Dec 22, 2010)

http://www.wpsmedicare.com/part_b/policy/active/local/_files/l29582_an030.pdf

The above LCD mentions some expections of the "trained observer"  during the procedure

Below is from CPT Assistant. I was unable to find anything else. You  could ask the head RN where you work if they feel the CMA would be qualify to be a "trained observer"? 


Clinical Example: 99144

A patient 5 years of age or older presents with a complaint necessitating performance of some procedure or service (ie, the "supported procedure"), in support for which moderate sedation is deemed clinically appropriate. The treating physician will perform both the supported procedure and the moderate sedation service.

Description of Procedure: 99144

The physician supervises the administration and induction of the sedating agent, with or without an analgesic, initiated by the independent, trained observer. The patient is observed until a safe and effective level of moderate sedation is achieved. The physician, assisted by the independent, trained observer, continually assesses the patient's level of consciousness and physiological status throughout the performance of the supported procedure. Additional doses of sedating agent are ordered by the physician, as needed, to maintain the achieved level of sedation for the supported procedure


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## EllieAnn (Jan 5, 2011)

*MAC vs. MCS*

I have  a similar question. Our Anesthesiologists will be administering only versed to patients undergoing MRI.Is this considered MAC or Moderate Sedation? I would normally bill 01922 for these procedures. But being told only versed will be used, got me wondering if I needed to bill with 99149. I haven't been able to locate any information or  fee schedules on these moderate sedation codes either. Does anyone know of any online sites that may be helpful? Thank you.


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## dwaldman (Jan 5, 2011)

I would ask inquire to the physician what level of sedation he believe it was or what was documented in the record

In the ASA Relative Value guide they address the differences but I do not have a electronic verison to copy and paste I did find an Anesthesia groups stance on MAC from looking on the internet. Though it is not a coding document it kind of goes over "qualified individual" and benefits of MAC

Key benefits of Monitored Anesthesia Care or MAC:

Only a licensed anesthetist or CRNA assesses and manages the patient's condition throughout the procedure.
Continuous monitoring increases patient safety and comfort. MAC provides cost-effective pain relief.
Even small doses of sedation medication can cause adverse physiological response. MAC requires a qualified CRNA or anesthetist who is trained to deal with any medical problems or complications that may arise during the procedure.
The healthcare professional delivering MAC monitors the patient's condition throughout the procedure and eliminates the need for additional medical staff during sedation or recovery.
Improves efficiency, quality of medical procedures and number of patients a facility can serve. Hospitals, surgery/ambulatory centers and office-based physicians can better manage patient volumes by using MAC.
While disturbing to know, it's a fact that in some medical centers propofol sedation is not administered or monitored by a qualified anesthesia provider. Outsourcing your anesthesia services to an established provider like Steel City Anesthesia LLC increases patient safety and reduces your liabilities — a win-win situation for your healthcare facility and the patient. MAC can mean the difference between safe, top quality healthcare and increased risks of complications or even death from overdose. Remember what happened to Michael Jackson?


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## dwaldman (Jan 5, 2011)

http://www.bing.com/search?q=distgu...re+from+conscious+sedation&form=QBLH&qs=n&sk=

I was able to find a PDF on the article in the Relative value guide titled

"Distinguishing Monitored anesthesia care ("MAC") from Moderate sedation/angelsia (Conscious sedation)

If the link I provided does not work, I used bing to search under Distinguishing monitored anesthesiac care from consicous sedation and it pull it as the first link.

I was also thinking about the other question in regards to if for example a Certified Medical Assistant can meet the criteria of a "trained observer". For eighty dollars for a non subscriber, you can poise this question on the AMA CPT Network. You could write up something that says, " I have exhausted all the resources available to determine answer to our question, I feel if it could be approved that the company pay for a submited question to the AMA, that the response would  benefit us." That way you could have something in writing from an official source and move on to other gray areas that also might need additional clarficiation.


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## EllieAnn (Jan 6, 2011)

Thank you so much.


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