Inpatient Facility Coding & Compliance Alert

Question: One of our physicians adds 99144 to his billing sheet whenever he performs epidural nerve block injections. None of the other physicians I code for have ever added the moderate sedation code to these injections. Is this something that is normally done?

Alabama Subscriber

Answer:  Some providers do use moderate sedation when performing pain management procedures, although others do not. If so, reporting 99144 (Moderate sedation services [other than those services described by codes 00100-01999] provided by the same physician or other qualified health care professional 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; age 5 years or older, first 30 minutes intra-service time) is appropriate if you have supporting documentation.

Caution: Be sure you’re familiar with the requirements for billing moderate sedation before submitting the claim. For example, the intra-service time for the moderate sedation must be 16 minutes or more to meet the time threshold of 99144. 

Note: In order for the physician to bill for the conscious sedation, the services must be provided in a freestanding setting.  If these services are provided in a hospital or facility setting, then the facility is paid for the conscious sedation.  See also the NCCI Coding Policy Manual for Medicare, January 1, 2014 Revision, Chapter I, Pages 24-25.