Gastroenterology Coding Alert

Question: I-ve heard rumors that CPT now bundles conscious sedation to endoscopic procedures. Is there any truth to this?


New York Subscriber

Answer: The rumors are true.

CPT Appendix G states that conscious sedation, as described by 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) and 99142 (- oral, rectal and/or intranasal), is an inherent component of more than 250 procedures, including many endoscopic procedures (such as 43200, Esophagoscopy, rigid or flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]);

CPT clearly states, -Since these services include conscious sedation, it is not appropriate for the same physician to report both the service and one of the conscious sedation codes,- and also clarifies, -The provision of conscious sedation by the operating physician includes the oversight of personnel who are monitoring the patient.-

These guidelines had no effect for gastroenterology practices billing Medicare payers because Medicare has disallowed separate payment for conscious sedation since 1998. On the other hand, they did guarantee that the remaining third-party payers that reimbursed separately for conscious sedation would no longer do so.

The guidelines do not affect anesthesiologists who provide conscious sedation using a dedicated anesthesia procedure code (rather than 99141, 99142).