Pediatric Coding Alert

When an adult gets a laceration on his or her face, the area can be numbed and stitched up, and the adult will cooperate by not moving around. A child is an entirely different matter, however. Conscious sedation is essential in the delivery of invasive and unpleasant procedures to children. And as of January 1, there are CPT codes for it:

99141 for intravenous, intramuscular, or inhalation sedation with or without analgesia; and

99142 is for oral, rectal, and/or intranasal sedation with or without analgesia.

However, there are guidelines that come with the code that must be followed. Here they are:

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. 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, and blood pressure). The use of these codes requires the presence of an independent trained observer to assist the physician in monitoring the patients level of consciousness and physiological status.

The essence of these standards is that the patient must be monitored. Note that an anesthesiologist does not have to be involved. A nurse, a physicians assistant, paramedics would all qualify to be the person monitoring the patient, according to the AAP. This person must be able to react to any changes in the patients status, and to initiate resuscitation if necessary. Since the pediatrician is busy performing the procedure, someone else must be doing the monitoring. You should document that the monitoring has taken place and who did it