Pediatric Coding Alert

Question: The outpatient department sometimes requests that a physician from our hospitalist pediatric group assist with dosing and administering oral sedation for pediatrics who are undergoing outpatient procedures, such as MRIs and radiology procedures. Many times the pediatric hospitalist has already performed an E/M service on the patient a week before the procedure to make sure the child can withstand the sedation. How should I code for the hospitalist dosing, administering and maintaining the conscious sedation?

New Jersey Subscriber

 Answer: The hospitalist should use a moderate sedation code (introduced in 2006). Based on the child's age and the sedation time, assign:
• 99148 -- Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician other than the healthcare professional performing the diagnostic or therapeutic service that the sedation supports; younger than 5 years of age, first 30 minutes intraservice time
• 99149 -- ... age 5 years or older, first 30 minutes intraservice time
• +99150 -- ... each additional 15 minutes intraservice time (list separately in addition to code for primary service.
 
CPT 2006 made several changes to the sedation codes, including deleting conscious sedation codes (99141-99142) and replacing them with moderate sedation codes (99143-99150) -- a term that better reflects the patient's clinical state. Unlike the conscious sedation codes, the moderate sedation codes do not distinguish between the sedation administration routes. The codes include all of the six possible routes of administration (intramuscular, intravenous, oral, rectal, intranasal and inhalation).
 
The codes also allow you to specify the physician's role in the sedation and/procedure. When the physician providing the moderate sedation does not perform the procedure, as in your case, you should assign 99148-99149 and possibly also 99150.
 
Example: A radiologist performs magnetic resonance imaging on a 2-year-old child. Because the patient's age will not allow him to hold still throughout the MRI prior to the procedure, a pediatric hospitalist orally sedates the patient. The hospitalist doses, administers and maintains the moderate sedation, which lasts for 20 minutes including intraservice time. The radiologist should report the MRI (such as 70551, Magnetic resonance [e.g., proton] imaging, brain [including brain stem]; without contrast material), and the pediatric hospitalist should code the sedation with 99148 for the first 20 minutes of intraservice time.
 
For ICD-9 codes, the hospitalist should use the same diagnosis as the radiologist that supports the medical necessity for the study, such as hydrocephalus (e.g., 742.3, Congenital hydrocephalus) or macrocephaly (756.0, Anomalies of skull and face bones).
 
Want more: For further details on the moderate sedation codes, use your online subscription service (OSS) (free with your paid subscription) to access the December 2005 Pediatric Coding Alert article "Learn 7 Must-Know Principles of Moderate Sedation Coding."