Anesthesia Coding Alert

Caution:  Anesthesia coders should steer clear if your MD provides MAC

Implementing CPT Codes 2006 on Jan. 1 means coding changes across the board, with updates in conscious sedation codes being of special interest to anesthesia and pain management professionals.
 
CPT 2006 eliminates the old conscious sedation codes 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) and 99142 (- oral, rectal and/or intranasal). Instead, CPT 2006 includes six new codes that give you more specific options in these cases:

- 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 health care professional performing the diagnostic or therapeutic service that the sedation supports; under 5 years of age, first 30 minutes 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).
 
The level of training a person needs to provide moderate sedation (as described in these codes) is different from that for deep sedation, explains Scott Groudine, MD, an Albany, N.Y., anesthesiologist. Individuals can only provide moderate or deep sedation or anesthesia after training to administer the drugs, monitor their effects and rescue patients from deeper levels of sedation than those intended.

New Terminology Helps Explain Code Choice

In addition to expanding code choices, CPT 2006 makes a terminology change, replacing the phrase -conscious sedation- with -moderate sedation- in an attempt to describe services more accurately. The new terminology and detailed sedation standards make determining whether you-ll use the codes easier.

-An anesthesiologist does not perform conscious sedation,- Groudine says. -Any moderate or deep sedation administered by an anesthesiologist is considered monitored anesthesia care (MAC). Only professionals with full anesthesia privileges can perform MAC because you must have the ability to convert to general anesthesia during the case if necessary.-

Anesthesia key: Don't fall into the trap of billing the new sedation codes if your anesthesiologist provides MAC services during a procedure. Instead, append MAC modifiers (such as G8, Monitored anesthesia care [MAC] for deep complex, complicated, or markedly invasive surgical procedure or QS, Monitored anesthesia care service) to the procedure code according to the carrier's MAC guidelines.

Pain management option: If you code for a pain management group, you might see the new sedation codes when your physician performs a nerve block (64400-64530, Injection, anesthetic agent) and opts to bring in a second physician to administer sedation for the patient during the procedure.

New Codes Spread the Work

Some professionals believe CPT expanded the sedation codes partly in response to increased demands on anesthesiologists. As services expand, physicians have so many cases that the anesthesia team can't cover all areas, says Burton Briggs, MD, of Loma Linda Anesthesia Medical Group in Loma Linda, Calif. The new codes and guidelines permit physicians in other specialties to administer conscious sedation for minor procedures (such as MRI, bone marrow aspiration or endoscopy procedures).

Carrier caution: Many carriers (such as Medicare and Medicaid) didn't reimburse for the old conscious sedation codes, so if you-re able to report 99143-99150 don't expect payment simply because CPT includes updated codes.

-A new CPT code makes it possible to bill for a procedure, but just because something has a CPT code doesn't mean it will be compensated,- Groudine warns. Check with your carriers for updated guidelines regarding the new moderate sedation codes before automatically including them with claims.