Reader Question: Sedation May Be Separate, but Doesn’t Pay

Question: When a physician performs a colonoscopy in an outpatient setting, can the facility bill for moderate sedation based on the nurse’s observation time and the drugs administered?

Arkansas Subscriber

Answer: Codes 99143-99150 (Moderate sedation services [other than those services described by codes 00100-01999 …]) have a status indicator of "N," which means that the APC includes the payment for the service.

Although Medicare won’t give you separate payment for moderate sedation, CMS still wants you to report it on a separate line because having that data affects how it determines codes and reimbursement in the future.

Note, however, that colonoscopies (45378-45392) are listed in CPT’s Appendix G -- which means you shouldn’t report them with moderate sedation codes 99143-99145 under any circumstances. Only if another physician (not a nurse) serves as the "independent observer" may the facility report 99148-99150, as appropriate, with codes appearing in Appendix G.