Pediatric Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: How can I tell whether a procedure I'm performing includes a value for sedation in other words, how can I tell whether I'm allowed to bill for conscious sedation?

California Subscriber


Answer: The best way to find out is to ask the payer. A work group at the relative value update committee (RUC) level is trying to answer the question: "Which codes include conscious sedation?" This process will probably be prolonged, but should result in a clear-cut answer.
 
Until then, the one scenario in which pediatricians might bill conscious sedation (99141-99142) is laceration repair. Make sure you have a nurse monitor the sedation, by constant pulse oximetry or some other method, as described in the code. Also, the code requires that the physician who performs the procedure must also be the physician who supplies the conscious sedation. If you provide conscious sedation in support of another physician, such as a pediatrician supporting a physician doing an MRI, you must bill an anesthesia code based on the specific surgery.