Neurology & Pain Management Coding Alert

Question: Our neurologist bills for conscious sedation of children during MRIs, CT scans, etc., using general anesthesia codes such as 01922. Is this correct?

Discussion Group Participant

Answer: No, 01922 (Anesthesia for non-invasive imaging or radiation therapy) and other general anesthesia codes are not correct to report conscious sedation. Rather, such codes describe procedures during which the patient is totally unconscious.

Sedation with or without analgesia (conscious sedation) is used 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. Conscious sedation includes performance and documentation of pre- and postsedation evaluations, administration of sedation and/or analgesic agent(s), and monitoring of cardiorespiratory function (pulse oximetry, cardiorespiratory monitor, and blood pressure). Codes 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) and 99142 ( oral, rectal and/or intranasal) should be used to report this procedure when the neurologist also performs the primary procedure (such as MRIs or CT scans).

The same physician who performs the primary procedure normally provides conscious sedation, although CPT does specify that an "independent trained observer" be present to assist the physician in monitoring the patient's level of consciousness and physiological status. Note that there is no provision for separate payment of the observer and that the observer need not be another physician.

The statement in CPT specifying "If the sedation with or without analgesia is administered in support of a procedure provided by another physician, see the anesthesia section" is directed specifically toward anesthesiologists. If the neurologist provides conscious sedation in support of another physician, he or she must consider local licensing rules and regulations and scope-of-practice laws before reporting an anesthesia code.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, consultant and CPC trainer for A+ Medical Management and Education in Absecon, N.J.