ED Coding and Reimbursement Alert

Question: A 34-year-old patient with a dislocated left shoulder reports to the ED. The ED physician sedates the patient to the point that he is relaxed but still conscious, then manipulates the shoulder back into place. Can we report 23655?

Illinois Subscriber

Answer: No, you should instead report 23650 (Closed treatment of shoulder dislocation, with manipulation; without anesthesia) for the reduction service. Code 23655 (- requiring anesthesia) is only for general anesthesia, not conscious sedation. While there is no universal definition for the term, general anesthesia typically means a state of total unconsciousness resulting from general anesthetic drugs. The patient you described was not under general anesthesia.

Alternate plan: If the same physician performs the sedation and the procedure, you may be able to account for the sedation by reporting 99144 (Moderate sedation services [other than those services described by codes 00100-01999] provided by the same physician performing the diagnostic or therapeutic service that the sedation supports -; age 5 years or older, first 30 minutes intra-service time) and 23650.

If a second physician provides the sedation, you could report 99148 (Moderate sedation services [other than those services described by codes 00100-01999] provided by a physician other than the health care professional performing the diagnostic or therapeutic -; age 5 years or older, first 30 minutes intra-service time) in addition to 23650.

Be careful: There are specific reporting rules for each of these codes, and you need to make sure the encounter satisfies those parameters before including 99144 or 99148. For more information on reporting conscious sedation codes, see -Reader Questions: Meet -Moderate- Guidelines for Sedation Coding- in ED Coding Alert,Vol. 11, No. 3.

Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.