Anesthesia Coding Alert

Question: My provider performs procedures in an ASC and also works with a nurse to provide the moderate sedation. Would the ASC bill this, or would I bill this when I bill the procedure?

Kentucky Subscriber

Answer: If the nurse provided the moderate sedation service, the anesthesiologist may not bill for the same service.

For example, see this clarification from Noridian: “When moderate sedation is performed in a facility setting (e.g., outpatient hospital, ASC) by the operating surgeon/endoscopist, one unit of 99152 is allowed, but the operating surgeon/endoscopy may not bill +99153, since +99153 is a ‘technical only’ code and Medicare considers that the independent trained observer represents an expense to the facility and may only be billed by the facility.”

So, only the person providing sedation can report 99152 (Moderate sedation services 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; initial 15 minutes of intraservice time, patient age 5 years or older).