ED Coding and Reimbursement Alert

Question: Because conscious sedation codes only apply when a patient is still verbally responsive, what if a provider gives deep sedation so he can perform a procedure, such as a shoulder reduction? Can we bill the shoulder reduction with modifier -47 and still report an anesthesia code for the deep sedation?

Michigan Subscriber

Answer: According to the American Medical Association publication Coding With Modifiers, you should append modifier -47 (Anesthesia by surgeon) when the surgeon provides her own regional or general anesthesia. In such a case, you would apply modifier -47 to the surgical code and not report anesthesia codes.

Most government carriers (such as Medicaid and Medicare), however, do not recognize modifier -47. If the physician has sedated the patient beyond the limits of conscious sedation (in which he retains the ability to respond to stimulation or verbal commands and to maintain airway-protective reflexes), you might choose the appropriate code from the anesthesia section. For more on this concept, see "Anesthesia Coding Knocking You Out?" in the July 2004 issue of ED Coding Alert.

You should also note that some payers refuse to pay non-anesthesiologists for these codes, and many facilities will not credential emergency physicians to provide anesthesia services.

Best bet: Verify the rules in your facility and with your payer.

 - Reader Questions and You Be The Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, vice president of Medical Reimbursement Systems Inc. in Stoneham, Mass.