# Conscious sedation billing



## DMEILER29 (Apr 21, 2015)

When billing procedure code 99144 for the first 30 minutes of sedation what are the rules as far as time?  Would the procedure have to be 16 minutes or more to bill for the service? If not able to bill for 99144 should you then bill for the IV access, oxygen, etc?  Thank you for your help!


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## chilipepper218@gmail.com (Apr 21, 2015)

Yes, I have in my margin notes that you cannot bill 99144 unless it's at least 16 minutes. I tried to find this in the Anesthesia Guidelines to give you a more definitive answer, but all it says is that "time for anesthesia may be reported as is customary in the local area."


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## DMEILER29 (Apr 21, 2015)

*Conscoius sedation billing*

Thank you for the response!  So does that mean that there is nothing he can charge for his services if the sedation is less than 16 minutes?  Should he bill for the IV insertion or the pulse oximetry?


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## dwaldman (Apr 21, 2015)

Those services would be bundled into the procedure.


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## DMEILER29 (Apr 28, 2015)

*Conscious Sedation Billing*

If the time for conscious sedation is less than 16 minutes procedure code 99144 is not billable.  In this scenario would it be appropriate to bill for the IV insertion and the pulse oximetry procedure codes in order for the physician to be compensated for his services?


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## dwaldman (Apr 28, 2015)

As seen below from the NCCI policy manual chapter one, states these services are not separately reportable.

CHAPTER I GENERAL CORRECT CODING POLICIES FOR NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL FOR MEDICARE SERVICES 

 Many procedures require cardiopulmonary monitoring either by the physician performing the procedure or an anesthesia practitioner.  Since these services are integral to the procedure, they are not separately reportable.  Examples of these services include cardiac monitoring, pulse oximetry, and ventilation management (e.g., 93000-93010, 93040-93042, 94760, 94761, 94770).


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## dwaldman (Apr 29, 2015)

Also stated is:

Intravenous access (e.g., CPT codes 36000, 36400, 36410) is not separately reportable when performed with many types of procedures (e.g., surgical procedures, anesthesia procedures, radiological procedures requiring intravenous contrast, nuclear medicine procedures requiring intravenous radiopharmaceutical).  After vascular access is achieved, the access must be maintained by a slow infusion (e.g., saline) or injection of heparin or saline into a ?lock?.  Since these services are necessary for maintenance of the vascular access, they are not separately reportable with the vascular access CPT codes or procedures requiring vascular access as a standard of medical/surgical practice.  CPT codes 37211-37214 (Transcatheter therapy with infusion for thrombolysis) should not be reported for use of an anticoagulant to maintain vascular access


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