READER QUESTIONS:
Apply Flat Fee to Sedation Codes
Published on Thu Jan 19, 2006
Question: When a pediatrician provides moderate sedation, how should I capture the charge for the procedure's base units? Also, should I use a physical status modifier?
Georgia Subscriber
Answer: A non-anesthesiologist provider, such as a pediatrician, should use the new moderate sedation codes (99143-99150). These codes eliminate the need to bill extra units to capture the procedure's base units. Therefore, you should ignore billable units and instead use new time-based codes.
Example: A 3-year-old child presents for an MRI that a radiologist performs. A pediatrician provides moderate sedation throughout the procedure. Sedation lasts 30 minutes. You previously would have coded the moderate sedation by a physician not performing the procedure with anesthesia code 01922. Because the procedure has 7 base units and 2 time units (15 minutes = 1 time unit), you would have billed 01922 x 9.
On 2006 claims, you should instead use the age-specific moderate sedation code that represents the pediatrician's assistant role: 99148 (Moderate sedation services [other than those described by codes 00100-01999], provided by a physician other than the healthcare professional performing the diagnostic or therapeutic service that the sedation supports; under 5 years of age, first 30 minutes intra-service time).
Because the sedation does not go into the 31st minute, you should not also report +99149 (... age 5 years or older, first 30 minutes intra-service time).
The physical status modifiers do not apply to the moderate sedation codes for non-anesthesiologists. For instance, in the above MRI case, if the patient had severe systemic disease you previously would have appended 01922 with P3 (A patient with severe systemic disease) to indicate the patient's status. For the level of physical status, you would bill an additional unit of 01922 for a total of 8 units. You should now simply report 99148.
Payment: The National Physician Fee Schedule does not assign relative value units to the sedation codes. Anesthesia codes are paid by locality and carrier, so payment comparison between the 2005 and 2006 method will depend on the insurer.
