ED Coding and Reimbursement Alert

Question: A patient comes to the ED with a dislocation of the patella. He is given Dilaudid and Valium IV, and the dislocation is then reduced. Would the CPT code for reduction be with anesthesia or without anesthesia?

Clearfield Hospital
Clearfield, PA

Answer: When the patella dislocates, it typically moves to the lateral side of the knee and off of the femoral condyles, says Cindy McMahan, CPC. Often, the physician is able to extend the knee, causing the patella to move back into its normal position without administering anesthesia. This is reported with 27560 (closed treatment of patellar dislocation; without anesthesia).

If the patient is in pain and guarding the area excessively, the physician may use anesthesia to relax the patient so the patella can be realigned. This would be reported with 27562 (closed treatment of patellar dislocation; requiring anesthesia).

Conscious sedation (the use of drugs like Valium and Versed) is routinely used for medical procedures such as cardiac catheterization, upper and lower endoscopy, dental procedures and outpatient surgeries and, with increasing frequency, difficult emergency department procedures that require the patient to be still (i.e., suturing of difficult lacerations, etc.). Unlike general anesthesia, conscious sedation allows the patient to be aware of his surroundings and enables him to communicate with the doctors and nurses during the procedure.

If the patient received this type of sedation rather than traditional anesthetic agents, and the sedation was provided by the physician who also performed the reduction of the patellar dislocation, codes 99141-99142 (sedation with or without analgesia [conscious sedation]) should be used in addition to the code for the dislocation without anesthesia (i.e., 27560).

Coders should also note that Medicare does not pay separately for conscious sedation; it considers it to be part of the overall procedure. The American Medical Association has indicated that it does not consider conscious sedation to meet the clinical definition of anesthesia. (See Avoid Denials by Not Using With Anesthesia Codes to Report Conscious Sedation on page 9 of the February 2000 ED Coding Alert.)