# Conscious sedation at ASC



## bearybubba2008 (Jul 15, 2015)

I'm curious if it is appropriate to bill conscious sedation when a patient receives it during a procedure at an ambulatory surgery center. I bill for the doctor, not the ASC. The doctor thinks that I should bill the conscious sedation as well as the code for the procedure performed. We are using the ASC's supplies, not our supplies (not sure if that makes a difference or not). 
For example, the dr performs a B/L ESI lumbar under conscious sedation (10 min). When I bill the dr charges, I would use 64483-50. Would I also bill for the 99144?

Thank you in advance for any help!


----------



## dwaldman (Jul 16, 2015)

To report CPT 99144, it is my understanding that the time documented for the conscious sedation in the medical record would have reach past the mid-point of thirty minutes which would be 16 minutes of conscious sedation. In the example you provided, you listed 10 minutes and in that case I don't believe you can report the service. I believe if there is an independent trained observer assisting with the monitoring that if the mid-point is passed that it could be reported. I am not aware of any guidance that states the trained observer has to be employee of the physician or the physician has to be the purchaser of the supplies/drugs.  

AMA CPT Assistant
August 2014 page 5

A Review of Reporting Time-Based Codes 



Non-Code Specific Instructions

In instances when time is the basis of code selection but code- or code range -specific instructions in the guidelines, parenthetical instructions, or code descriptors do not provide specific increments of time, refer to the time instructions given in the Introduction section of the CPT code book. According to the codebook's instruction, "A unit of time is attained when the mid-point is passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and sixty minutes). A second hour is attained when a total of 91 minutes have elapsed. When codes are ranked in sequential typical times and the actual time is between two typical times, the code with the typical time closest to the actual time is used (CPT Pro 2014, page xv)." 

To illustrate further, when reporting Physical Medicine and Rehabilitation code 97110, Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility, a time-based code can be reported for each 15-minute unit. Multiple units can be reported on a date of service for one or more procedures based on the aggregate amount of time spent by a qualified health care professional in direct contact with the patient. As with any 15-minute timebased code, it is important to recognize that a substantial portion of the 15 minutes must be spent in performing the pre-, intra-, and postservice work in order to report the time-based code. If only five minutes are spent performing the physical medicine service, the code should not be reported. If a person is seen by a physician or qualified health care professional for therapeutic procedure exercises to develop strength, endurance, flexibility, motor control, and cardiopulmonary capacity related to performance of work tasks, and these exercises are performed for 23 minutes of face-to-face time with the provider, the time guidelines in the Introduction would be the prevailing instruction for reporting the time-based code. Therefore, two units of code 97110 would be reported because 23 minutes is greater than the midpoint between 15 minutes and 30 minutes, qualifying for two units

Question: How is moderate sedation that was performed for 35 minutes reported? Is this reported differently with the revised 2011 time guidelines? In the past, add-on code 99145 and 99150 would be reported in addition to the base code (99143, 99144, 99148, and 99149) for the first 30 minutes. Is this reported differently with the revised 2011 time guidelines? 

Answer:Yes. After the initial 30 minutes of moderate (conscious) sedation is performed, sedation time must continue past the midway point (8 minutes) of the 15 minutes given in the add-on code descriptor, in order to report add-on codes 99145, Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; each additional 15 minutes intra-service time (List separately in addition to code for primary service), and 99150, Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes intra-service time (List separately in addition to code for primary service). Therefore, a minimum of 38 minutes of moderate (conscious) sedation must be performed to additionally report one of these add-on codes.


----------



## bearybubba2008 (Jul 30, 2015)

Thank you so much for your response! I appreciate it very much.


----------

