ED Coding and Reimbursement Alert

Correctly reporting the performance of conscious sedation in the emergency department (ED) has been a long-standing controversy in emergency medicine. ED physicians must make the distinction between a state of unconsciousness and without any sensation to the area when selecting the appropriate code.

As defined by CPT 2000, conscious sedation is used in tandem with a medical procedure to achieve a medically controlled state of depressed consciousness while maintaining the patients airway, protective reflexes and ability to respond to verbal commands. Conscious sedation includes performance and documentation of pre- and post-sedation evaluations of the patient, administration of the sedation and/or analgesic agent(s) and monitoring of cardiorespiratory function.

Commonly, conscious sedation is used when performing delicate and painful or long proceduresfor example, laceration repairon children, the elderly and other adults in certain situations.

In 1998, CPT added two codes for this service: 99141 (sedation with or without analgesia [conscious sedation]; intravenous, intramuscular, or inhalation) and 99142 (sedation with or without analgesia [conscious sedation]; oral, rectal and/or intranasal). Some payersMedicare includedconsider conscious sedation to be bundled into the overall service provided to the patient and do not recognize the conscious sedation codes. To get reimbursed for the additional service related to conscious sedation when the payer does not reimburse for it, some groups have been reporting the overall service with a code that specifies with anesthesia (i.e, 23655, closed treatment of shoulder dislocation, with manipulation; requiring anesthesia).

Note: For more information, see the article Update on Conscious Sedation: When Should You Report an E/M Level or Anesthesia Code? on page 44 of the June 1999 ED Coding Alert.

New Information: Avoid With Anesthesia

Pat Moore, vice president for reimbursement for Healthcare Business Resources, Inc., an emergency medicine billing company in Durham, N.C., however, has received a clarification from the American Medical Association (AMA) indicating that this practice is not appropriate.

I had the opportunity to ask Celeste Kirschner, MHSA, director of CPT Editorial and Information Services at the AMA, about using surgical codes that include the language with anesthesia, she says. According to her, when a CPT code states with anesthesia and the type of anesthesia is not specified, the term anesthesia should be interpreted as general anesthesia.

Moore says she interpreted Kirshners statements to exclude conscious sedation. We are no longer reporting conscious sedation with these codes, Moore explains. According to the new information provided by Kirschner, the CPT editorial panel considers conscious sedation to be analgesia [directed at pain relief] rather than anesthesia [numbing of sensation].

Generally, the CPT Editorial Panel considers [...]