Anesthesia Coding Alert

Question: Our CRNA was called into the hospital emergency room to provide intubation for a patient. The doctor decided not to intubate and asked the CRNA to provide IV sedation for a CT scan of the head. The total procedure time was 45 minutes. How would you code this? Can 99149 and 99150 be used?

Pennsylvania Subscriber

Answer: A surgeon typically administers IV sedation, which could be reported with either 99149 (Moderate sedation services [other than those services described by codes 00100-01999], provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; age 5 years or older, first 30 minutes intra-service time) or 99150 (… each additional 15 minutes intra-service time [List separately in addition to code for primary service]). 

When administered by an anesthesia provider instead or a surgeon, however, monitored anesthesia care (MAC) is distinguished from the moderate sedation codes the surgeon reports. However, the CRNA should have both a pre- and post-anesthesia evaluation and a time-based graph to support the service. Because MAC is usually not required for a CT scan of the head, the CRNA’s documentation should include notes supporting the medical necessity of reporting 01922 (Anesthesia for non-invasive imaging or radiation therapy).