ED Coding and Reimbursement Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.


Question: What is the correct way to code conscious sedation? I work for eight emergency department (ED) physicians who all code differently. Some say code for pain; some say for procedures only.

Teri Chapman Strayhorn
Bigfork, Mont.


Answer: Conscious sedation codes 99141 and 99142 (sedation with or without analgesia [conscious sedation]) are recognized CPT codes but are treated differently by individual carriers. Medicare assigns these codes a B status, which means they are bundled into whatever procedural service they are associated with. Medicare will not pay separately for conscious sedation. Other carriers do recognize these codes, however, and follow the guidelines in the CPT manual.

To answer your specific questions, the intent of conscious sedation is to place the patient in a situation where some other procedure or service can be performed. This seems to exclude pure pain as a reason. CPT guidelines note that conscious sedation can be with or without analgesia, indicating the priority for the sedation component, not the analgesia.

With respect to the documentation required, the physician must note in his or her charting the presence of a second person whose job is to monitor the patient throughout the sedation and procedure. That person is usually a nurse.

The physicians documentation must include the type of monitoring that the patient had, mainly pulse oximetry, and the chart should contain separate readings throughout the procedure. The use of conscious sedation is an individual physician preference, so its performance will vary.

More and more, conscious sedation is becoming the standard of care, and all physicians should be encouraged to seek training in its use and include appropriate documentation in the chart each time it is performed.

The source for You Be the Coder is John Turner, MD, PhD, FACEP, medical director for coding and documentation at TeamHealth, an emergency physician staffing firm in Knoxville, Tenn.