Anesthesia Coding Alert

Question: Our anesthesiologist used fentanyl and propofol to provide sedation during a 4-year-old child’s intrathecal chemotherapy. The oncologist is billing 96450. Should we bill 00635 or 99155 for the sedation?

Wisconsin Subscriber

Answer: Although your anesthesiologist administered sedation, that doesn’t mean you automatically report 99155 (Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age) or other moderate sedation codes.

As you see in the CPT^® coding guidelines, the moderate sedation codes are for situations not covered by anesthesia codes 00100-01999: “Moderate sedation codes 99151, 99152, +99153, 99155, 99156, +99157 are not used to report administration of medications for pain control, minimal sedation (anxiolysis), deep sedation, or monitored anesthesia care.”

Translation: An anesthesiologist should report the applicable anesthesia code for sedation instead of 99155 or related codes.

The surgeon plans to report 96450 (Chemotherapy administration, into CNS (eg, intrathecal), requiring and including spinal puncture). This crosses to anesthesia code 00635 (Anesthesia for procedures in lumbar region; diagnostic or therapeutic lumbar puncture), which carries a base value of 4. You should submit 00635 with the applicable number of time units for your physician’s sedation services.