ED Coding and Reimbursement Alert

Question: Recently, the attending physicians in our ED have been calling anesthesia residents in to administer "procedural sedation" with Midazolam and Propofol. Should we report this using anesthesia codes or conscious sedation codes? If we opt for anesthesia codes, should the attending ED doctors earn the professional fee for supervising the anesthesia residents?


Alabama Subscriber


Answer: The answer to your question hinges on quite a few "ifs." But this much is certain: You can't report anesthesia codes if the same physician performs or supervises the procedure and the sedation. Instead, you should report conscious sedation codes. Depending on the carrier, you may or may not get reimbursement for conscious sedation.

Step one: The first two things you need to figure out are which doctor is performing the procedure - the orthopedist or the emergency department physician - and whether that doctor is a resident or an attending physician. Then you need to find out how many physicians were involved and who performed each part.

There are several possible scenarios to consider:

 1. If the attending anesthesia physician is supervising and responsible for the anesthesia resident, and the ED attending physician performs the procedure, then the anesthesia attending bills for the anesthesia service and the ED attending physician bills for the procedure.

2. If the ED attending physician is supervising the ED resident as well as the anesthesia resident, you really have both the procedure and the sedation under the umbrella of a single provider. In this case, the ED attending physician would bill both the conscious sedation codes and the procedure codes.

3. Another common scenario: The orthopedic resident performs the procedure with the ED resident (or attending) sedating the patient. If there is appropriate involvement by the orthopedist attending, the ED team bills for the anesthesia service and the orthopedist bills for the procedure work.