Neurology & Pain Management Coding Alert

Question: When providing MRIs, CT scans, etc., to children (or particularly uncooperative adults), our neurologists sometimes provide conscious sedation. May I report this service with an anesthesia code, such as 01922?

New York Subscriber

Answer: You may report either 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) or 99142 (... oral, rectal and/or intranasal), as appropriate, to describe conscious sedation when the neurologist also performs the primary procedure (such as an MRI or a CT scan).

Physicians employ sedation with or without analgesia (conscious sedation) to achieve a medically controlled state of depressed consciousness while maintaining the patient's airway, protective reflexes, and ability to respond to stimulation or verbal commands. The procedure includes performance and documentation of pre- and post-sedation evaluations, administration of sedation and/or analgesic agent(s), and monitoring of cardiorespiratory function (i.e., pulse oximetry, cardiorespiratory monitor, and blood pressure). The documentation must indicate that an independent, trained observer was present to assist the physician in monitoring the patient's level of consciousness and physiological status.

You should not report 01922 (Anesthesia for non-invasive imaging or radiation therapy) for physician-administered conscious sedation. This code is used to bill a general anesthesia procedure in which the patient is totally unconscious. Some confusion is understandable, however, given CPT's statement that "If the sedation with or without analgesia is administered in support of a procedure provided by another physician, see the anesthesia section." This instruction is meant to apply to anesthesiologists who are only providing conscious sedation for another physician.

If a neurologist provides conscious sedation on a patient for another physician, you must review the licensing rules and scope-of-practice regulations (which may vary from state to state for neurologists) prior to reporting an anesthesia code (such as 01922) for a neurologist.