# Moderate conscious sedation



## 01096327 (Nov 24, 2009)

I have a patient that came into the Emergency Room with a shoulder dislocation.  The CRNA came down and administered Versed to the patient, and the ER doctor reduced the disclocation.  The patient is 66 and was under for a total of 20 minutes.  Would you bill a 99149-QZ (our CRNA's are not under the direction of an anesthesiologist) for the CRNA's part of the service?  Am I correct in saying that this is considered moderate conscious sedation, and is this the only cpt code we would bill for the CRNA?

Thanks
Kathy


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## deedeefronius (Nov 24, 2009)

I would use 99149-QZ and -23.  Since you don't usually use sedation for a uncomplicated shoulder reduction, the -23 modifier indicates unusual anesthesia.  I hope this helped!


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## 01096327 (Nov 25, 2009)

How do you determine what is unusual anesthesia?  I don't know a lot about anesthesia billing so any information you can give me on this would be very helpful. 

Thanks

Kathy


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## jdrueppel (Nov 30, 2009)

Are you sure this was not Monitored Anesthesia Care?  
If the anesthesia provider fully documented an anesthesia service (i.e. pre-anes evaluation/intra-operative monitoring...) then this might be billable under ASA code 01620 QZQS plus time (place of service 23).  I would review your documentation and/or confirm the mode of anesthesia with the anesthesia provider.

Julie, CPC


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## 01096327 (Dec 7, 2009)

I am not really sure what I am supposed to bill.  I have never billed anesthesia before and have kind of been thrown into this.  How to I tell if the patient had moderate conscous sedation or general anesthesia or do I ask the CRNA and go with what he says.  I am not sure if the CRNA here knows the difference, he claims he only does general anesthesia and that is it.


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## jdrueppel (Dec 7, 2009)

Did the anesthesia provider fully document an anesthesia record for the service? 

Julie, CPC


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## 01096327 (Dec 10, 2009)

No, he just gave me the CPT codes he wanted me to bill and his minutes.


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## CatLaw (Dec 16, 2009)

This may be reported as MAC.  You should have an anesthesia record to accompany this service.  Although it may be possible the CRNA did conscious sedation, but especially if it was done in a hospital setting and possible done in the O.R, I would look into it.  It very well could be MAC.


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