Gastroenterology Coding Alert

Question: Some insurance companies will reimburse for conscious sedation as part of the anesthesia track if the description used is administration of sedation and includes the length of time for the anesthesia procedure. CPT does not address this matter, however, and conscious sedation is a valuable service that gastroenterologists perform. How do I furnish documentation for this and attempt to have the overall issue addressed?

Kim Matticks
Valley Gastroenterologists
Allentown, Pa.

Answer: Although conscious sedation is a valuable service to the patient, Medicare does not reimburse gastroenterologists for administering it during a procedure. There are some commercial insurers, however, that will reimburse for the service.

The CPT guidelines for the anesthesia section include the phrases the administration of sedation and time reporting for anesthesia, which are similar to those mentioned in the question. There are also some codes listed in that section that might give the impression that common gastrointestinal procedures are covered, such as 00740 (anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum) and 00810 (anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum). The section also includes some discussion of modifier -47 (anesthesia by surgeon) that is to used to report regional or general anesthesia provided by a physician also performing the services for which anesthesia is being provided.

Anesthesia is not the same as conscious sedation, however, and the anesthesia section of CPT is mainly applicable to anesthesiologists, not gastroenterologists. Patients under general anesthesia will experience a complete loss of consciousness. CPT defines conscious sedation, on the other hand, as a state of depressed consciousness but not a total loss of consciousness. A patient under conscious sedation retains the ability to respond to stimulation or verbal commands. Gastroenterologists usually will administer conscious sedation when performing endoscopic procedures. The use of general anesthesia for endoscopic procedures is infrequent.

The only CPT codes that can be used to report conscious sedation administered by a gastroenterologist are 99141 (sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) and 99142 (oral, rectal and/or intranasal). And as stated before, those will not be reimbursed by Medicare and occasionally reimbursed by private insurers.