Neurology & Pain Management Coding Alert

Question: I've heard that CPT will begin bundling conscious sedation to MRIs, CT scans and other tests. Is there any truth to this? Our neurologist sometimes uses conscious sedation for younger or hard-to-manage patients.

New York Subscriber

Answer: CPT does not bundle conscious sedation to magnetic resonance imaging (MRI) or computed tomography (CT) scans at this time. However, Appendix G of CPT 2005 now states that conscious sedation, as described by 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) and 99142 (... oral, rectal and/or intranasal), is an inherent component of over 250 codes, including many surgical procedures (such as endoscopic procedures).
 
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."

Be careful to note that regardless of CPT's instructions, Medicare has disallowed separate payment for conscious sedation since 1998. Private or third-party payers should still allow you to bill 99141 if you have done so in the past.

 - 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, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.