Ophthalmology and Optometry Coding Alert

Question: I've heard rumors that CPT 2005 bundles conscious sedation into endoscopic procedures. Is there any truth to this?


Illinois Subscriber


Answer: The rumors are true. 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 or intranasal), is an inherent component of over 250 codes. So far, the only affected code in the "Eye and Ocular Adnexa" section is 66720 (Ciliary body destruction; cryotherapy). All of the codes that include conscious sedation are marked with a special icon in most CPT manuals.

Warning: 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."

The changes will have no effect for ophthalmology practices billing Medicare payers because Medicare has disallowed separate payment for conscious sedation since 1998. The changes to CPT do guarantee that the remaining third-party payers that reimbursed separately for conscious sedation may no longer do so with the specially marked CPT codes.
 
Note, however, that the new guidelines do not affect anesthesiologists who provide conscious sedation using a dedicated anesthesia procedure code.

You can view a complete list of the codes affected by the conscious sedation bundles in Appendix G of CPT 2005 or CPT 2005 Changes: An Insider's View.