Anesthesia Coding Alert

Most local Medicare carriers, such as Empire Medicare Services in New Jersey and parts of New York, and Georgia Medicare, do not cover conscious sedation codes 99141-99142, stating that the service is already included in the primary procedure.

Empires local medical review policy, for instance, states:

Effective for services provided on or after January 1, 1998, codes 99141-99142 are a status (B) on the Medicare Fee Schedule Data Base. Therefore, these procedure codes are bundled into payment for other services and are not paid separately. Payment for the administration of anesthesia by the operating physician or the assistant surgeon is included in the global surgical allowance. If the physician bills a separate fee for the surgery (or assistance at surgery) and the anesthesia, payment should be made only for the surgery (or the assistance at surgery.) A separate fee for the anesthesia should be denied as part of the global surgical package.

Georgia Medicare lists 99141-99142 among its bundled services. Codes that are designated bundled services are not payable separately, nor should they be billed to Medicare or the patient. These are considered incident to another service performed on the same day or any other day. If any of [these services] are billed to Medicare, each will be denied as included in another service. Physicians may not collect from the patient, or the patients supplemental insurance, for bundled services. To do so would represent a limiting charge violation or an assignment violation...

Many private carriers also do not cover this service. For example, Pennsylvania Blue Shield doesnt pay for conscious sedation under most of its plans, and directs billers not to use 99141 and 99142, but rather to bill the appropriate surgical code with a local modifier attached.

Note: Although HCFA does not cover conscious sedation, the service must be documented so the record can show whether the physician or another member in the practice administered it.

Although Medicare will deny the claim, Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C., urges, Charge [conscious sedation] in at $0 and dont bill Medicare. But document it. Good record keeping should be thorough, regardless of whether a service is billed.