# Conscious Sedation by NP



## Juliette0416 (Dec 15, 2009)

I have a physician that is trying to code/bill for having the NP perform CS--99144 & 99145. Also, he believes there is an RVU attached to these codes by CMS which I was able to research and find out was not correct. 

It is my understanding per the guidelines (CMS) that CS is either performed by the physician performing the procedure or a separate physician, there is no mention of NON physician providers being able to administer same let alone bill.

The other kicker is on the patient list, next to the patient name is written in "MAC" which the NP certainly would not be credentialed to perform.

Can anyone point me in the right direction if in fact I am in correct? Thanks SO Much!!

Juliette


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## CatLaw (Dec 16, 2009)

I was very surprised to come across this post because I myself have been working on the same thing.  Here is some good info for you: when another person other than the physician performing the therapeutic or diagnostic procedure administers the conscious sedation, it can be an anesthesiologist, resident, fellow, nurse anesthetist or even an RN. If a RN can administer it, I am sure a NP can too. As far as RVU...I was told to charge 1 unit or $100, whichever is higher.  So for instance, if your office charges $110 per unit, charge that.  If your office charges $80 per unit, go up to $100.  Only an anesthesiologist can perform "MAC".  Basically, a surgeon's way of billing "MAC" is by billing conscious sedation.  They are very similar but "MAC" I believe is a little more involved.  So because a surgeon cannot bill for "MAC", their way of billing it is by billing conscious sedation.  Does this make sense?  I hope all this helps.  Oh, and another thing.. be careful of the medicines the physician uses.  RNs and NPs are not qualified to administer Propofol.  It is such a powerful drug that only anesthesiologists are qualified to administer.  Versed is the drug most physicians use for conscious sedation.


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## linwill3 (Apr 1, 2010)

I bill for Critical Care physicians that do consious sedation and use propofol.  Not on every pt but some.  At least in FL our physicians are aloud to administer it.


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## hgolfos (Apr 1, 2010)

The guidelines from the ASA indicate that the difference between MAC and Conscious Sedation (Moderate Sedation) is the level of consciousness reached.  It also indicates that a physician can bill for conscious sedation for a procedure which he/she is performing as long as there is a clinically qualified observer monitoring the patient throughout the procedure.  The physician can instruct the NP to administer versed, fentanyl, demerol and or morphine.  See the link below for more info on this.  Hope it helps.  http://www.asahq.org/publicationsAndServices/sedation1017.pdf


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