Otolaryngology Coding Alert

-Appendix G- can tell you when to bundle CS

CPT 2006 includes a major overhaul of conscious (or moderate) sedation (CS) codes, but the guidelines for these services are still a bit tricky. Read on to unravel the riddle of when your ENT can report CS separately.

-Targeted- Procedures Include CS

If you see a procedure code in the CPT manual with a -dot inside a circle- (which looks like a target -bull's eye-) next to it, you-ll know that you shouldn't report CS separately with that procedure, says Michael A. Granovsky, MD, CPC, FACEP, vice president of Medical Reimbursement Systems, an ED billing company in Stoneham, Mass.

Instructions contained in CPT's Appendix G explain that certain codes include conscious sedation -as an inherent part of providing the procedure. These codes are identified in the CPT codebook with [the target] symbol.- The instructions go on to note that if the same physician provides a -targeted- code and the CS, -it is not appropriate - to report both the service and the sedation codes 99143-99145.-

Watch for: Targeted codes include some endoscopic procedures common in ENT practice, such as bronchoscopy (31622-31629), but do not include other common procedures (such as laryngoscopy 31510-31579).

Bottom line: You can't bill separately for CS using 99143, 99144 or 99145 (see -6 New Codes Expand Your Conscious Sedation Options- at right for complete definitions of the new CS codes) if your otolaryngologist provides both CS and a targeted service (for instance, 31622, Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]).

Monitor Vital Signs

When the primary physician provides CS, an independent, trained observer should be on hand to monitor the patient.

Documentation should provide proof of the observer's presence and note that he monitored the patient's cardiorespiratory functions (pulse oximetry, cardiorespiratory monitor, and blood pressure) for the duration of the CS. In addition, the physician should record a pre- and postsedation assessment, Granovsky says.

Frequently, this documentation is recorded -using an institutional CS flow sheet that is filled out by the nurse for the bedside vital signs and co-signed by the doctor,- Granovsky says.
 
Place of Service Matters for 99148-99150

You may be able to report 99148-99150 for CS during a targeted procedure, says Kelly Dennis, MBA, CPC, ACS-AP, president of Perfect Office Solutions Inc. in Leesburg, Fla., but the service must meet two requirements:

1. As required by the code descriptors, a second physician (not the physician providing the service that supports the CS) must provide the CS.

2. The targeted procedure supporting the CS and the CS must take place in a facility setting (such as a hospital, outpatient hospital/ambulatory surgery center or skilled nursing facility).

Not in the office: You cannot bill 99148-99150 in the physician's office or other nonfacility setting, even if a second (different) physician provides the CS while the primary physician renders the targeted service that supports the CS, according to newly added CPT language.

Stay Away From 52

If your ENT does not provide CS during a targeted procedure, because -the patient does not require sedation,- you do not need to append modifier 52 (Reduced services).

In other words: You will not gain extra reimbursement for providing CS in most cases, but neither will your payment decrease if you don't provide CS.