# Deep Sedation in ED



## dtweedy (Dec 21, 2011)

Can an ED physician use the Anesthesia codes 00100 - 01990 for deep sedation when he/she performs the sedation in the ED?

I am certified in Anesthesia coding and I do not feel comfortable in using these codes, because of the qualifying modifiers that are attached to these codes. AA, AD, QK, QX, QZ.

If I am wrong please advise.

Thanks,
 DGarcia.


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## LeslieJ (Dec 22, 2011)

Hi,

There are several questions one needs to ask:  how deep is "deep" ?  Who is doing the monitoring of the patient?  What kind of surgeon is administering the anesthesia? Do the ED physicians follow the same reporting guidelines for ASA or are they following the Emergency Sedation protocols by ACEP?

In my facitlies, "deep sedation" is similar to "MAC" because we are billing the TYPE of anesthesia, not the level of depth of sedation.  Are your physicians noting the level of depth of sedation also?

Chances are very good that in the ED setting, without a qualified anesthetist (CRNA or Anesthesiologist or DO), they are performing a "Moderate Sedation" per the ACEP Guidelines.

See here for what I mean:
http://www.acep.org/Content.aspx?id=75479&terms=moderate sedation guidelines
http://www.acep.org/WorkArea/DownloadAsset.aspx?id=80509
http://www.acep.org/Content.aspx?id=30480&terms=sedation

The last link given will tell you some coding guidelines.  Where it's more likely that they are doing "Moderate Sedation", then the correct codes to be choosing are *not* those anesthesia codes you mentioned.  The correct coding may be the 99141-99150 codes.

Look a little deeper (no pun intended) for what they're actually doing & see if the links I've provided help.

L J


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