ED Coding and Reimbursement Alert

In the March issue of ED Coding Alert we covered the reporting of conscious sedation performed in the ED (Correctly Code for Conscious Sedation in the ED, pages 17-19). Since that issue, we have received several additional reader questions on this topic. For example, how should you report conscious sedation if it is performed by a second physician and not the physician performing the main procedure? And, when is conscious sedation considered bundled into the code for the procedure?

First, conscious sedation codes (99141-99142) should not be used if the sedation is performed by another physician (i.e., one physician performing the surgical procedure and another physician solely dedicated to performing the conscious sedation), says John Turner, MD, medical director of documentation and coding compliance for Knoxville, TN-based TeamHealth, Inc. an multi-state emergency physician practice management group.

CPT states that if conscious sedation is administered in support of a procedure provided by another physician then the anesthesia codes should be used, Turner explains.

These codes (00100-01444) are used for any anesthetic administered by a physician, not just for general anesthesia that is administered in an operating room, the physician adds.

The anesthesia code is selected based on the part of the body that is undergoing a surgical procedure. For example, conscious sedation performed by another physician in support of a facial laceration repair would be reported using 00100 (anesthesia for procedures on integumetary system of head and/or salivary glands, including biopsy; not otherwise specified).

Procedure Codes That Include Anesthesia

However, anesthesia codes and conscious sedation codes should not be used in conjunction with a procedure code with a CPT definition that states requiring anesthesia, explains Pat Moore, vice president of reimbursement for Healthcare Business Resources, Inc., an emergency medicine billing company in Durham, NC.

For example, CPT lists two codes for closed treatment of shoulder dislocation, with manipulation. The definition for the first code, 23650, states without anesthesia. The next code, 23655, is for the same procedure, but the definition states requiring anesthesia.

The second code indicates the administration of anesthesia, so conscious sedation would not be separately billable, she states.

For third-party payers that do not recognize the conscious sedation codes, it might be preferable for coders to choose a code for the procedure that included the statement requiring anesthesia, because the reimbursement would normally be higher than for the corresponding without anesthesia codes, Moore advised readers in the previous ECA article.

Since publication of that issue, she has received numerous comments from ED coders who believed that the requiring [...]