ED Coding and Reimbursement Alert

Question: Is conscious sedation with endotracheal intubation a separately billable service if the physician documents the service appropriately?

Ohio Subscriber

Answer: Under current CPT guidelines, the answer is no if the ED physician supervised or performed the conscious sedation. Conscious sedation requires strict documentation, and Medicare may not pay for it in conjunction with another service. For instance, according to CPT, administering drugs prior to intubation does not qualify as conscious sedation and, therefore, is not a separately identifiable service. Clinically, most people feel that rapid sequence intubation is the standard of care, and use of paralytic is bundled with 31500 (intubation, endotracheal, emergency procedure).

Note: For more information on billing conscious sedation, see the November 2000 ED Coding Alert, page 81.