General Surgery Coding Alert

NCCI 12.1 takes aim at sedation with endoscopies

The National Correct Coding Initiative version 12.1 (effective April 1-June 30, 2006), which newly classifies 107 codes as components of moderate sedation (99143-99150), might not affect your reimbursement for Medicare payers, but it could have important implications for  proper coding.

Watch these bundles: As of April 1, you-ll need a modifier (such as modifier 59, Distinct procedural service) if you want to bill for moderate sedation with intracatheter introduction (36000), venipuncture (36400-36410, 36420-36425), hydration (90760) and many injection procedures, among others. This is Medicare's way of saying that it won't pay separately for any of these procedures in addition to moderate sedation, unless the bundled procedure occurs for a different reason or at a separate anatomic site.

Moderate sedation codes 99143-99144 also become components of 543 codes, including 73 codes from the respiratory and cardiovascular surgery sections, 16 cardiovascular therapeutic services codes, and 48 codes from the cardiac medicine section.

And many surgical endoscopy codes (43200-43272, 44360-44500 and 45303-45392) will now include conscious sedation, as will all E/M services. You won't be able to use a modifier to override any of those edits.

Translation: You won't be coding separately for conscious sedation with certain endoscopies or during any E/M visit.

You May Not Mind the Cents

The new edits might not have much effect on your reimbursement for Medicare payers. -These services were historically considered bundled, and I see nothing yet that indicates they have changed their minds,- says Margaret Loftus with Stanford Hospital and Clinics.

In fact, many procedures that may warrant conscious sedation don't include the cost of that service, but carriers deny separate payment for 99143-99144 anyhow, says Carrie Ontiveros, coding specialist with the Wichita Clinic in Wichita, Kan. Codes 99143-99144 have no relative value units (RVUs), and Medicare has granted them -C- status. In practice, such -carrier-priced- codes aren't paid at all.

-CPT guidelines specifically outline which services include conscious sedation.- But physicians who perform conscious sedation -are basically providing a free service,- at least for Medicare carriers, Ontiveros adds.

Why care? The important point for Medicare payers is: In the past, you were free to code for conscious sedation (and, from the standpoint of complete coding, you should have done so) in addition to ERCP (43260, Endoscopic retrograde cholangiopancreatography ...), for instance. From this point forward, you should no longer even report 99143-99144 separately with procedures to which NCCI bundles them.

Remember: Non-Medicare payers may indeed pay for 99143-99144, and you can always specify reimbursement for conscious sedation during your contract negotiations. So don't assume private payers won't reimburse you just because Medicare won-t.

Learn more: For complete information on new-for-2006 conscious sedation codes 99143-99144, see -Wake Up and Learn Your New CS Codes,- in the February 2006 General Surgery Coding Alert on page 13.