Gastroenterology Coding Alert

Question: Can I bill 99144 with an EGD or colonoscopy? I have never billed the conscious sedation codes, but I have recently started working for another gastroenterologist, and her office typically bills them with the procedures.

New Mexico Subscriber

Answer: You don't have to bill separately for conscious sedation (sometimes referred to as moderate sedation). It's included in the codes. That's what the 8 symbol in front of the codes means.
 
If you see a procedure code in the CPT manual with (which looks a lot like a target -bull's eye-) next to it, you-ll know that you shouldn't report moderate sedation separately with that procedure, says Michael A. Granovsky, MD, CPC, FACEP, vice president of Medical Reimbursement Systems, an billing company in Stoneham, Mass.
 
Instructions contained in Appendix G of CPT explain that certain codes include conscious sedation -as an inherent part of providing the procedure. These codes are identified in the CPT codebook with a bullseye symbol.-
 
The instructions go on to say that if the same physician provides a -targeted- code and the moderate sedation, -it is not appropriate - to report both the service and the sedation codes 99143-99145.-
 
Targeted codes include many endoscopic procedures common in GI practice, including esophagoscopy (43200-43232), upper GI endoscopy (43234-43259), proctosig-moidoscopy (45303-45327) and colonoscopy (45355-45392), among others.
 
Just the facts: You can't bill separately for 99143, 99144 or 99145 if your gastroenterologist provides both moderate sedation and a targeted service (for instance, 43234, Upper gastrointestinal endoscopy, simple primary examination [e.g., with small-diameter flexible endoscope] [separate procedure]).