ED Coding and Reimbursement Alert

Question: When the ED physician performs a fracture reduction, is conscious sedation included or should I report it separately?


Alabama Subscriber
Answer: No, conscious sedation isn't technically included in the code for the fracture reduction. However, payers that follow Medicare rules don't reimburse for conscious sedation services in the emergency department. For private payers, you'll need to check with the individual carrier, because they may have varying policies on this issue.

If you have sufficient documentation, you may potentially include the risk associated with the conscious sedation in your E/M service and capture high risk in the medical decision-making (MDM) risk table.

The following codes include conscious sedation administration:

31615 - Tracheobronchoscopy through established tracheostomy incision

31622 - Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing (separate procedure)

32020 - Tube thoracostomy with or without water seal (e.g., for abscess, hemothorax, empyema) (separate procedure)

33010 - Pericardiocentesis; initial

33210 - Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter (separate procedure)

36555 - Insertion of nontunnelled centrally inserted central venous catheter; under 5 years of age

36568 - Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; under 5 years of age

92953 - Temporary transcutaneous pacing

92960 - Cardioversion, elective, electrical conversion of arrhythmia; external.