Pediatric Coding Alert

Question: Our pediatrician spent two hours providing rectal conscious sedation with Brevital for a patient undergoing a magnetic resonance imaging (MRI) of the head. How can we get paid for this?

New Mexico Subscriber

Answer: In this situation the pediatrician can use only the conscious sedation codes (99141, 99142). Although CPT directs coders to the anesthesia codes, if the sedation with or without analgesia (conscious sedation) is administered in support of a procedure provided by another physician, no codes in the anesthesia portion of CPT accurately describe rectal conscious sedation with Brevital.

Conscious sedation is normally provided by the same physician performing the primary procedure. CPT specifies that an independent trained observer be present to assist the physician in monitoring the patients level of consciousness and physiological status, but does not require that the observer be another physician.

This question raises another question: Why didnt the radiologist who performed the MRI also provide the conscious sedation? If the answer has to do with liability, the pediatrician may wonder why he, and not an anesthesiologist, was called upon to provide the sedation. If the hospital requires that a physician, rather than a nurse, provide the sedation, you should agree on a reimbursement policy with your hospital prior to performing the service. Payment for 99141 or 99142 will not compensate adequately for two hours of physician time, which is why the service is usually billed by the same physician who performs the procedure.