Cardiology Coding Alert

The existence of a CPT code for a procedure or service is no guarantee of reimbursement. No codes better illustrate this point than 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) and 99142 ( oral, rectal and/or intranasal).
 
Conscious sedation (CS) is used routinely during cardiology procedures, including cardiac catheterizations, cardioversions, transesophageal echocardiography and electrophysiology studies.
 
Unlike general anesthesia, which affects the patient's involuntary functions and requires the presence of an anesthesiologist to monitor the patient, CS allows the patient to enter a state of depressed consciousness yet maintain involuntary functions such as breathing and protective reflexes.
 
Under CS, the patient can also respond to verbal commands or other stimulation. Instead of an anesthesiologist, a trained observer (such as a nurse or physician assistant) must monitor the patient.
 
When CPT introduced the CS codes in 1998, many cardiologists expected reimbursement for the service. That same year, however, CMS announced that CS was included in the accompanying procedure's surgical package. Medicare and Medicaid carriers were quick to enforce this directive.
 
For example, a policy of Empire Medicare Services (the Part B carrier in New Jersey and parts of New York) states that "99141-99142 are a status (B) on the Medicare Fee Schedule Data Base (MFSDB). Therefore, these procedure codes are bundled into payment for other services and are not paid separately."
 
Many private carriers follow Medicare's lead and do not pay for CS. Some cardiology practices may standardize their billing according to Medicare guidelines and not bill any payer for the service, says Savannah Siens, CPC, CCS-P, billing office manager with Northland Cardiology, a 10-cardiologist practice in Kansas City, Mo.
 
"CS may be covered by a few carriers, but most don't pay for it, and it's more efficient to go with one standard of billing practice. If it isn't covered by Medicare, I'm inclined not to report it," she says.
 
Not all cardiology coding specialists share Siens' view: Sueanne Bicknell, RHIA, CPC, CCS-P, director of compliance with Cardiology and Internal Medicine Associates in Dallas, recommends reporting conscious sedation to all non-Medicare payers unless and until specifically directed not to. "CS should be billed to non-Medicare carriers and if they pay it, fine. If they say it is inclusive, the charge should be written off, but you should bill it," Bicknell says. "Every payer is different. The only payer who should not be charged is your local Medicare carrier."
 
Carriers who cover the service usually pay only under the following conditions:
   A procedure must be performed. When the cardiologist performs a heart cath and uses conscious sedation to anesthetize the patient, this requirement has been fulfilled. Conscious sedation for pain relief typically is not covered.
   In a facility, the [...]