# MRI with sedation



## kellit21

We perform MRI's in our office and one of our physicians has requested we start giving sedation to those patients who are claustrophobic. Does anyone have any guidelines and codes we would have to use for this, or is this even a payable service? Our physician will be the one administering the sedation while the MRI tech performs the MRI.


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## dwaldman

01922  
Anesthesia for non-invasive imaging or radiation therapy  

Here is the CPT above for Monitored Anesthesia Care provided for MRI. Below is general guidelines form the CMS Internet-Only-Manual. 

 Monitored Anesthesia Care  The Part B Contractor pays for reasonable and medically necessary monitored anesthesia care services on the same basis as other anesthesia services.  Anesthesiologists use modifier QS to report monitored anesthesia care cases.  Monitored anesthesia care involves the intra-operative monitoring by a physician or qualified individual under the medical direction of a physician or of the patient?s vital physiological signs in anticipation of the need for administration of general anesthesia or of the development of adverse physiological patient reaction to the surgical procedure.  It also includes the performance of a pre-anesthetic examination and evaluation, prescription of the anesthesia care required, administration of any necessary oral or parenteral medications (e.g., atropine, demerol, valium) and provision of indicated postoperative anesthesia care.  
Payment is made under the fee schedule using the payment rules in subsection B if the physician personally performs the monitored anesthesia care case or under the rules in subsection C if the physician medically directs four or fewer concurrent cases and monitored anesthesia care represents one or more of these concurrent cases.


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## kellit21

I have been told it will only be conscious sedation... does this change anything?


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## dwaldman

When reviewing the code descriptors, it appears that the physician is not the one performing the actual diagnostic procedure as seen with 99144 and 99145, So I was looking more towards 99149/99150. I also include the time guidelines of the mid-way point for coding add on code and additional units. 

99149  Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; age 5 years or older, first 30 minutes intra-service time 

99150  Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes intra-service time (List separately in addition to code for primary service) 



99144  Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional 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 patient's level of consciousness and physiological status; age 5 years or older, first 30 minutes intra-service time 

99145  Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional 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 patient's level of consciousness and physiological status; each additional 15 minutes intra-service time (List separately in addition to code for primary service) 

" the new Time guidelines in the Introduction to CPT 2011 overrides the instructions published in the February 2006 CPT Assistant issue. Based upon current CPT guidelines, the appropriate reporting of moderate sedation performed by an independent observer on an adult that lasts 35 minutes would be reported with only code 99144. The rationale for reporting is that when codes are ranked in sequential typical times and the acutal time is between two typical times, the code with the typical time closest to the actual time is used. The ?35 minutes? is closer to the stated time in code 99144 (first 30 minutes intra-service time). A unit of time is attained when the mid-point is passed. Therefore, in order to report an additional 15 minutes of intra-service time (as represented by code 99145 and 99150), the mid-point of 7.5 minutes must be passed."


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