# Anesthesia code



## nabernhardt (Aug 15, 2011)

A patient was brought in ER and had bilateral proximal humerus fractures.  The ER P.A. placed the patient in arm immobilizers.  Anesthesia was brought in for this and utilized a total of 90 mg of propofol.  Were able to obtain light sedation.  Would there be an anesthesia code to use for this?


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## nabernhardt (Aug 20, 2011)

just seeing if there is even an anesthesia code that we can use for this? any suggestions please.


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## Mojo (Aug 20, 2011)

Is this homework or do you have additional information? If the sedation is not minimal, deep or requiring monitored anesthesia care, look at the Moderate (Conscious) Sedation code 9914x. When coding in the ED setting, there is usually a moderate sedation flowsheet in the medical record when moderate sedation is given.


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## Peter Davidyock (Aug 21, 2011)

Yes there is but the anesthesiologist will be billing it not the ER Doc.


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## Mojo (Aug 21, 2011)

Oceanlivin said:


> Yes there is but the anesthesiologist will be billing it not the ER Doc.



I agree, the moderate sedation would not be reported by the EDP in this scenario. I should have been more clear. My statement was meant to emphasize looking for the flowsheet when procedures are performed with sedation to gather more information.


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## nabernhardt (Aug 21, 2011)

no this is not homework and thats why I didnt think I could use the moderate sedation codes as this is performed by the CRNA.  Why I'm having difficulty is because the procedure was really only the ER doc putting on the arm immobilizers and I dont think there is a procedure code for that would there be.  I think that would be included in the E & M.  So am I still able to apply an anesthesia code for this.  I'm open to suggestions.  Thank you for those who have responded


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## nabernhardt (Aug 21, 2011)

Sorry but I really dont have any more information than that like I had said the CRNA came in and administered sedation for the ER doc.   I'm not sure what more that I could add that would be helpful.  I'm just trying to find a code to capture this for the CRNA.


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## Mojo (Aug 21, 2011)

So, there is no Moderate Sedation flowsheet?  Is there documentation to support 99149 - drug, time, O2 sats, HR, BP, RR, patent airway, level of sedation? CRNAs do administer moderate sedation (depending on state scope of practice and facility policy).

If the EDP isn't billing for fracture care, documentation may support shoulder strapping, 29240.


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## nabernhardt (Aug 22, 2011)

ok just because I am not very good at coding anesthesia.  Could I use 01620 for this.  The CRNA did do a moderate conscious sedation record but I always thought that the 99149 sedation codes were only for when physicians administer sedation and if it was a Anesthesiologist or CRNA we had to use Anesthesia codes?  If you would be able to explain I would appreciate it.  I am confused some. Thank you


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## Mojo (Aug 23, 2011)

99148-99150 codes are used when the provider administered the moderate sedation but did not perform the procedure (fracture care, endo). Hopefully, someone who specializes in anesthesia has a definite response with resources on whether moderate sedation billing is indicated.

Since Propofol has the propensity for deeper levels of sedation you might be able to code for MAC if you have the documentation.

In order to bill 01620, the definition for anesthesia services must be met. What about 01730? 

http://www.asahq.org/Search.aspx?q=anesthesia+care+mac+moderate+sedation


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## Peter Davidyock (Aug 24, 2011)

If the xrays indicate fractures to the head or the neck of the humerus it will be 01620. Anything lower will be 01730 mentioned by Mojo.
You will need an anesthesia start and stop time. 
You will need the approprite QZ, QX. A physical status above three for commercial carriers will also apply.
Your billing software should be loaded with the appropriate Taxonomy codes for the crna and the correct values for the anes cpts. If you are going to bill the dme you will need the correct HCPCS II code for the propofol.
I am somewhat confused by the question you are posing though. Are you billing for the crna or the ed dr or both?


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## chatelaine (Aug 24, 2011)

have you looked at 01730 to bill for your CRNA? I would probably use that one


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## chatelaine (Aug 24, 2011)

find out what code the EDP is billing for the fractures, run the codes thru CCI edits and use 01730 if no bundling issues. Good luck


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