Ob-Gyn Coding Alert

Discover the 1 exception to the -targeted- code rule
 
When your physician performs moderate (or conscious) sedation on a patient, you may be tempted to neglect reporting the sedation to the insurer. After all, many carriers still don't reimburse for the service, which CPT anointed with a new code set in 2006.

Leaving these codes off the claim could be a mistake, however, because some insurers have started paying for moderate sedation, says Robert LaFleur, MD, of Medical Management Specialists in Grand Rapids, Mich.

-Reimbursement for moderate sedation has been spotty,- he says. But LaFleur goes on to say that some payers have started paying for certain types of moderate sedation.

Additionally, Medicare designated these codes as -carrier-priced- to gather information for utilization and proper pricing.

-Many Medicare carriers are beginning to recognize moderate sedation,- says Michael Granovsky, MD, CPC, president of MRSI, a coding and billing company in Woburn, Mass. So while you may not get paid every time you report moderate sedation, including it on the claim when you-re allowed to is a good idea.

Benefit: The more times an insurer sees moderate sedation codes on claims, the more likely it will be to consider paying for the service in future policy decisions.

If you are confused about coding for these services, check out this primer on the ins and outs of moderate sedation coding. Use 99144-99145 for Procedure, Sedation You should see two sets of moderate sedation codes, which are separated based on the number of physicians involved. You-ll choose from one of these codes when the same physician performs the sedation and the procedure (or service), says Cheryl Tereba, a manager of revenue recovery for UMass Memorial Healthcare in Worcester, Mass.:

- 99144 -- 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; age 5 years or older, first 30 minutes intra-service time

- +99145 -- ... each additional 15 minutes intra-service time (list separately in addition to code for primary service). Remember: When using moderate sedation codes, you must be sure the medical record contains a thorough explanation of the medical necessity for performing this service. Don't Code Separately for IV Establishment
 
 When you provide moderate sedation, you should not report the following services, because they-re included:

 - Assessing the patient (not included in intraservice time)

 - Establishing IV access and fluids to maintain patency, when performed

 - Administering agent(s)

 - Maintaining sedation

 - Monitoring oxygen saturation, heart rate and blood pressure

 - Recovery (not included in intraservice time).
Remember: Intraservice time starts with the administration [...]