ED Coding and Reimbursement Alert

It seems too good to be true you can report an anesthesia code for conscious sedation administered by an emergency physician. Under certain circumstances, the substitution is allowed, though you should employ it with caution.

Conscious sedation is a medically controlled state of depressed consciousness, during which the patient maintains control over the airway and can usually respond to verbal commands, says Jan Loomis, director of coding and documentation at TeamHealth West, Pleasanton, Calif.

But for anesthesia services, the physician may actually control the patient's airway, she says. There is a spectrum of potential consciousness states for anesthesia. For example, many cystoscopies are done with intravenous Versed, and the patient is awake and able to have a conversation with the anesthesiologist. Frequently with these lighter forms of anesthesia, there is an ongoing verbal exchange between the anesthesiologist and the patient regarding comfort. You should report an anesthesia code if an emergency department physician administered conscious sedation for another physician performing surgery. According to a published comment by the American Medical Association: "If an anesthesiologist or other physician is administering the conscious sedation [for a physician performing the surgical procedure], then the appropriate code from the anesthesia section (00100-01999) should be reported by the other physician."

You should report the conscious sedation codes, 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) or 99142 (... oral, rectal and/or intranasal) for a physician who also provides the surgical procedure.

But it would be inappropriate to use the conscious sedation codes in the case of one physician assisting the other performing the procedure, Loomis says. How Your Coding Affects Payment More opportunities to employ anesthesia instead of conscious sedation codes mean more reimbursement. Medicare and many payers that follow Medicare do not pay for conscious sedation, Loomis says. The service is considered bundled into the surgical procedure, she explains.

So, assigning an anesthesia code can mean additional reimbursement. For example, a very nervous 10-year-old female presents with an infected pilonidal cyst. One physician performs the incision-and-drainage procedure. Due to the depth of sedation required for the patient with Versed and fentanyl, a second emergency department physician provides the anesthesia service. You would report the incision and drainage with 10080* (Incision and drainage of pilonidal cyst; simple) or 10081 (... complicated), and the additional anesthesia service with 00902 (Anesthesia for; anorectal procedure) for the 10080 drainage of a pilonidal cyst. But some things never change: Conscious sedation and anesthesia codes "pose reimbursement problems," Loomis says. Be prepared for denials, even though experts forecast payment for anesthesia when an assisting physician is administering conscious sedation in the ED.

The "main problem" with assigning anesthesia codes to conscious sedation services is that the [...]