Gastroenterology Coding Alert

Be sure to document medication and dose when reporting CS

Revisions in CPT 2006 mean you will now have the option of reporting conscious sedation (CS) if your physician provides the sedation service and a different physician provides the primary service--but you will have to be extra precise when documenting time.

Time Is Now an Important Factor

For 2006, you-ll find that CPT has deleted 99141-99142 and now contains six new codes to describe conscious (or moderate) sedation. CPT divides the codes into two groups based on whether the same physician  provides CS and performs the procedure (99143-99145), or whether one physician oversees the sedation in support of a second provider who performs the procedures (99148-99150), says Michael A. Granovsky, MD, CPC, FACEP, vice president of Medical Reimbursement Systems, an ED billing company in Stoneham, Mass.:

- 99143--Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; under 5 years of age, first 30 minutes intra-service time

- 99144--... age 5 years or older, first 30 minutes intra-service time

- +99145--...each additional 15 minutes intra-service time (list separately in addition to code for primary service)

- 99148--Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician other than the healthcare professional performing the diagnostic or therapeutic service that the sedation supports; under 5 years of age, first 30 minutes of intra-service time

- 99149--...age 5 years or older, first 30 minutes intra-service time

- +99150--...each additional 15 minutes intra-service time (list separately in addition to code for primary service).

Because CS is now a -time-based- (and -aged-based-) service, the physician must document the time CS began and ended, as well as the patient's age, in addition to the type and dose of medication (for instance, -1 mg Versed-), says Kelly Dennis, CPC, ACS-AP, president of Perfect Office Solutions Inc. in Leesberg, Fla.

-Age is easy enough to document, but practices are going to have to pay special attention to time. This could be easy to overlook because time was not a factor with the previous conscious sedation codes,- Dennis says.

You should report 99143 for the first 30 minutes of CS to a patient younger than 5 years of age if the same physician provides both the CS and the primary procedure.

Report 99148 for the first 30 minutes of CS to a patient under 5 years of age if the your physician provides CS in support of a different physician who provides the primary procedure.

Similarly, report 99144 for the first 30 minutes for a patient 5 years or older if the same physician provides the CS, or 99149 if a different physician provides the CS.

Apply -Add-ons- Carefully

Codes 99145 and 99150 are -add-on- procedures. You would report 99145 in addition to 99143-99144 only if the physician provides CS for longer than 30 minutes, and you would never report 99145 or 99150 alone, Dennis says.

By the same token, you should report 99150 with 99148-99149 for each additional 15 minutes beyond the first 30 minutes that a second physician provides CS.

Example: The gastroenterologist provides CS for a 50-yr-old patient who complains of severe discomfort during a diagnostic proctosigmoidoscopy (45300). Because this is not a -targeted- procedure, CPT rules allow you to report CS separately (for complete information on targeted procedures and when you separately report CS, see -CPT Clarifies Conscious Sedation Billing-). An independent observer monitors the patient during CS, which lasts for a total duration of 20 minutes.

In this case, you would report the proctosigmoidoscopy (45300, Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]), along with 99144 for the CS. Because the duration of the CS did not exceed 30 minutes, you may not report any units of 99145 in addition.