ED Coding and Reimbursement Alert

Age differences and add-on codes hit the scene in 2006

Out with the old, in with the new: Starting Jan. 1, 2006, you can scrap conscious sedation (CS) codes 99141-99142 and usher in six new codes for moderate (conscious) sedation (99143-99150). These codes account for time spent, so make sure your physician's documentation is on the dot.
 
Conquer the Age Divide
 
For 2006, you-ll find CPT contains six new codes to describe moderate sedation (MS). CPT divides the codes into two groups based on whether the same physician is providing MS and performing the procedure (99143-99145), or whether one physician is overseeing the sedation in support of a second provider who is performing the procedures (99148-99150), says Michael A. Granovsky, MD, CPC, FACEP, vice president of Medical Reimbursement Systems, an ED billing company in Stoneham, Mass.

Because MS is now a time-based and aged-based service, you must document--in addition to the type and dose of medication (for instance, -1 mg Versed-)--the time MS began and ended, as well as the patient's age.

Remember: MS time begins with the -administration of the sedating agent, requires continuous face-to-face attendance, and ends at the conclusion of personal contact by the physician providing the sedation.-

You should report 99143 for the first 30 minutes of MS to a patient under 5 years of age if the same physician provides both the MS and the primary procedure. Report 99148 for the first 30 minutes of MS to a patient under 5 years of age if the your physician provides MS in support of a different physician who provides the primary procedure.

Similarly, report 99144 for the first 30 minutes for a patient 5 years of age or older if the same physician provides the MS (or 99149 if a different physician provides the MS).
 
Check Your Watch for Add-On Codes
 
Codes 99145 and 99150 are -add-on- procedures. You would only report 99145 in addition to 99143-99144 if the physician provides in excess of 30 minutes of MS. By the same token, you should report 99150 with 99148-99149 for each additional 15 minutes beyond the first 30 minutes that a second physician provides MS.

Example: The ED physician provides MS for a 50-year-old patient who is undergoing treatment for a dislocated shoulder. Because this is not a -targeted- procedure, CPT rules allow you to report MS separately. The physician provides 20 minutes of face-to-face intraservice moderate sedation time.

In this case, you would report the nontargeted procedure code 23650 (Closed treatment of shoulder dislocation, with manipulation; without anesthesia) along with 99144 for the MS. Because the duration of the MS intraservice physician face-to-face time did not exceed 30 minutes, you may not report any units of 99145 in addition.

Don't Count on Big Bucks Yet

-A new CPT code may be helpful, but just because a procedure has a code doesn't mean payers will compensate you,- says Scott Groudine, MD, an Albany, N.Y., anesthesiologist.

In years past, Medicare considered conscious sedation procedures 99141-99142 bundled services in all cases, and therefore would not pay separately for them. Although 99143-99150 are much more precise than 99141-99142--which could lead to a change in CMS policy--most experts are skeptical that Medicare will revise its guidelines concerning moderate sedation.

To date, Medicare has assigned zero physician relative value units (RVUs) to the MS codes, but it does indicate that they will be -carrier-priced.- This means individual Medicare carriers may determine the payment for the codes. Time will tell what price, if any, that will be.