ED Coding and Reimbursement Alert

Question: A 17-year-old patient reports to the ED with an injured lower left leg. The ED physician orders x-rays, which confirm a scaphoid fracture; notes indicate the bone fragments were not aligned or in proper position. The patient reports extreme pain during the exam, and becomes very anxious when he learns of the pending surgery, so the ED physician performs 22 minutes of moderate sedation while performing closed treatment of the fracture. The physician then casts the injury and instructs the patient to report to an orthopedist for follow-up care. Can I report the x-rays and conscious sedation separately?California SubscriberAnswer:  You can report moderate sedation -- provided the encounter satisfies the requirements for 99149.As long as the 22 minutes of sedation time meets the following guidelines, you can code separately for the sedation:Sedation time officially started with administration of therapeutic agent.There was continuous face-to-face attendance between patient and physician (or other [...]