# Coding/Billing for deep sedation in the ED



## rodriguj

I am trying to set up charges for deep sedation when done in the Emergency Department using two Emergency Dept Physicians. The fx codes that include anesth in their descriptions are no problem. But, what about for Cardioversion procedures or other fx procedures that don't have "anesth" in their descriptions. Also for complicated lac repairs done on special needs patients or children? Any guidance would be appreciated. Thanks, J


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## alisonbee

*Moderate Sedation in the ED*

Refer to Appendix G in the CPT book for a list of codes that include moderate sedation.


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## OCD_coder

Procedures with anethesia included in the CPT codes are for OR only.  This is for general anesthesia (not MCS) and these are never done in the ER.

Moderate conscious sedation is only done in the ER due to the risk to the patient.  An anethesiologist may come to the ER to do the MCS.
Whether they call it deep sedation or not, it is still just MCS in the ER setting.

If you are billing procedures under anesthesia, this is incorrect.

For children needing sedation due to their mental handicap for procedures not usually needing sedation, use the modifier 23 with the MCS code appropriate for what was done.

Cardioversion requires MCS and is included in the 92960.  See appendix G, these are referring only to MCS sedation.

Remember, just giving a drug to heavily sedate does not necessarily qualify as MCS.  There are specific guidelines to meet before MCS an be billed.


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## rodriguj

Sorry not true . . . we do both Deep and Moderate sedation in our ED's.  The physcians all had to be certified by Anesthesia and there must be two physicians present for the procedures.  Propofol is used for deep sedation.


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## sam_son 

My self , do agree with mworcester, 

It is ok that Ed physician can give anesthesia , but in Emergency Department they will not provide General anesthesia it will be provided in OR . 

So while coding fracture care provided in ED with Sedation we will use Fracture care or dislocation care code with out anesthesia and we need to code Moderate sedation code . 

 Fracture care provided with anesthesia will be done in OR not in ER. 

Yes Cardioversion is included in Sedation no need to code separately when coding MS.

If 2 physician involved in Fracture care :
 In case ortho physician provides Fracture care and ED physician provides sedation  - We will Bill ED physician with 99148 to 99150 , And Fracture care will be billed for Ortho physician separately but can't bill for ED.


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## jknox

If the ER Doc. is using Propofol "Deep Sedation" how do you bill for it on the pro side?


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