Dont Mix Conscious Sedation and Consultation Codes
Published on Sun Nov 01, 1998
Although adult patients dont have to be sedated for x-rays, pediatric patients sometimes do. Young children almost always have to be sedated for MRIs and CAT scans. And, most pediatric patients (and adults as well) need to be sedated for endoscopies. So, pediatricians were delighted when the new codes for conscious sedation99141 and 99142made their appearance in the 1998 CPT. However, sometimes its not immediately obvious how new codes will work in combination with other codes.
We tried using the conscious sedation codes as soon as they came out, says Sharon Villamil, billing manager for the Department of Pediatrics at the Childrens Hospital at Albany Medical Center, which has seven primary care pediatricians and 23 subspecialists. We received no payment at all. Was it because the insurance companies hadnt loaded the new codes yet? Possibly. But the solution Villamil found didnt end up working either. Heres what happened.
On a regular basis our critical care physicians perform conscious sedations on pediatric patients who are seen on an outpatient basis for procedures such as MRIs and endoscopies, says Villamil. Critical care physicians are involved by the request of pediatricians in the community, as well as by the request of the specialists performing the procedures, the billing manager notes. They request the intensivists because the treatment involves sedation of a child, which is sometimes more risky, says Villamil.
So, the pediatric specialists did the procedures, with intensivists administering the sedation and monitoring vital signs. At first, Villamil used the first conscious sedation code: 99141. This is for intravenous, intramuscular, or inhalation sedation, because intravenous administration is what they use.
Now, things start to get a little complicated.
Consultation Codes
Our physicians, in addition to performing the conscious sedation, also examine the patient prior to the procedure and bill for a consultation, says Villamil.
This can get you into trouble, advises Liz Munn, practice plan manager at Childrens Hospital, Medical University of South Carolina, in Charleston. The conscious sedation codes call for an exam pre and post. I wouldnt do it, she states, referring to billing the consultation codes.
Indeed, CPT makes it clear that conscious sedation does include the exams. Sedation with or without analgesia (conscious sedation) is used to achieve a medically controlled state of depressed consciousness while maintaining the patients airway, protective reflexes, and ability to respond to stimulation or verbal commands, CPT states. Conscious sedation includes performance and documentation of pre-and post-sedation evaluations of the patient, administration of the sedation and//or analgesic agent(s), and monitoring of cardiorespiratory function (i.e., pulse oximetry, cardiorespiratory monitor, [...]
