General Surgery Coding Alert

Reporting CS with a -targeted- service puts a denial bull's eye on your claim. If you-re not coding for the moderate sedation (also known as conscious sedation or CS) your surgeon performs during a procedure, you-re potentially costing your practice money for every procedure he uses moderate sedation for. How much depends on your payer. "Coders shouldn't assume they cannot report the sedation," says Lisa Center, CPC, physician billing certified professional coder with Mt. Carmel Regional Medical Center in Pittsburg, Kan. "They need to check the codes to see if the code includes sedation and, depending on the setting, they might be able to use one of the conscious sedation codes." Make sure you-re not losing precious reimbursement with these expert tips on moderate sedation coding. Check the Number of Providers The moderate sedation codes are divided into two sections based on who is providing the moderate sedation: - The physician performing the procedure: 99143-99145 (Moderate sedation services [other than those services described by codes 00100-01999] provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status -) - A physician other than the provider performing the procedure: 99148-99150 (Moderate sedation services [other than those services described by codes 00100-01999], provided by a physician other than the healthcare professional performing the diagnostic or therapeutic service that the sedation supports -) "Both sets of codes are then further broken down based on the age of the patient and incremental time," says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla. "Additionally, both sets make it clear that the moderate sedation codes are for sedation other than those described by the anesthesia codes. Moderate sedation does not include minimal sedation (anxiolysis), deep sedation, or monitored anesthesia care (MAC)." "Use 99143-99145 when services are provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status," Center explains. Plus: Revisions in CPT 2006 mean you also now have the option of reporting moderate sedation if your physician provides the sedation service and a different physician provides the primary service.When a second physician -- a physician other than the one performing the diagnostic or therapeutic services -- provides moderate sedation in a facility setting (e.g., hospital, outpatient hospital/ambulatory surgery center, skilled nursing facility, etc.), you would report 99148-99150 if you are coding for the second physician (who provided the sedation). However, for the circumstance in which [...]