ED Coding and Reimbursement Alert

Question: How should our ED pediatrician code and bill for administering conscious sedation if another physician performs a procedure, such as a fracture repair?

Laurie Larsen, Office Supervisor
ED Primary Childrens Medical Center, Salt Lake City

Answer: This problem arises from CPT because the instructions for conscious sedation state, If the sedation with or without analgesia (conscious sedation) is administered in support of a procedure provided by another physician, see anesthesia section. But that section of the book refers to general anesthesia only. Conscious sedation does not appear in the anesthesia section and thus is not considered an anesthesia code.

This difference may be addressed by CPT in the future, but for now you may have to cover this as an issue without any clear answers. Many experts say they would bill it out under the physician who did the procedure of conscious sedation (in your case the pediatrician) because there is no other option.

Also, in most cases, codes 99141 (sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) and 99142 (... oral, rectal and/or intranasal) may not be paid when the physician does not perform the procedure related to the conscious sedation.