Coding Corner: Don’t Count Out Conscious Sedation With ‘Targeted’ Surgery Codes

 If you meet 2 requirements, you can report both services

Conscious sedation coding underwent a complete overhaul earlier this year -- thanks to CPT 2006, you had six new codes with revised guidelines to learn. While CPT 2006 gave you new options and regulations on reporting conscious sedation (CS), these expert tips will help you determine when to separately report CS services.
CPT 2006 deleted codes 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) and 99142 (… oral, rectal, and/or intranasal) and introduced in their place six new codes under the term “moderate sedation.”
Moderate sedation is the same service previously reported as conscious sedation. It is a relaxed state of consciousness that is achieved by administering medication intravenously or orally. Individuals are awake but drowsy, and able to maintain their airways and ability to respond to stimulation or verbal commands.
To code correctly with the new moderate sedation codes, you must be sure your documentation provides the necessary details in three areas:
1. Identify the provider. CPT divides the new CS codes into two groups based on whether the same physician provides CS and performs the procedure (99143-99145), or whether one physician oversees the sedation (99148-99150) in support of a second provider who performs the primary procedure, says Michael A. Granovsky, MD, CPC, FACEP, vice president of Medical Reimbursement Systems, an ED billing company in Stoneham, Mass.:

• 99143 -- Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician 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; under 5 years of age, first 30 minutes intra-service time

• 99144 -- ... age 5 years or older, first 30 minutes intra-service time

• +99145 -- ... each additional 15 minutes intra-service time (list separately in addition to code for primary service)

• 99148 --Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician other than the healthcare professional performing the diagnostic or therapeutic service that the sedation supports; under 5 years of age, first 30 minutes of intra-service time

• 99149 -- ... age 5 years or older, first 30 minutes intra-service time

• +99150 -- ... each additional 15 minutes intra-service time (list separately in addition to code for primary service).
2. Mind the time. The new CS codes are time-based but have no base units, says Barbara J. Johnson, CPC, MPC, owner of Real Code Inc. in Moreno Valley, Calif. This eliminates the need to bill extra units to capture the procedure’s base units.
3. Watch your patient’s age. The CS codes are also [...]

- Published on 2006-07-11