General Surgery Coding Alert

Question: I've heard rumors that CPT will bundle conscious sedation to endoscopic procedures. Is there any truth to this?


New York Subscriber


Answer: The rumors are true.

Appendix G of CPT 2005 now states conscious sedation, as described by 99141 (Sedation with or without analgesia [conscious sedation] intravenous, intramuscular or inhalation) and 99142 (...oral, rectal or intranasal), is an inherent component of over 250 codes, including most procedures a general surgeon might perform.

A few examples of procedures into which CPT 2005 bundles conscious sedation include:

endoscopic procedures (such as 43200, Esophagoscopy, rigid or flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]);
  percutaneous incision and drainage (including 49021, Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess; percutaneous); and,
  central line placement procedures (for example, 36555, Insertion of non-tunneled centrally inserted central venous catheter; under 5 years of age). 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."

The changes will have no effect for general surgery practices billing Medicare payers because Medicare has disallowed separate payment for conscious sedation since 1998. The changes to CPT do guarantee that the remaining third-party payers who reimbursed separately for conscious sedation will no longer do so.
 
Note, however, that the new guidelines do not affect anesthesiologists who provide conscious sedation using a dedicated anesthesia procedure code.

You can view a complete list of the codes affected by the conscious sedation bundles in Appendix G of CPT 2005 or CPT Changes 2005 - An Insider's View.