Primary Care Coding Alert

Coders say some insurers are paying for sedation
 
Do you report moderate (or conscious) sedation when your FP performs this service on a patient? If you do not, you-re not alone -- but you could be losing out.
 
Many carriers are still not reimbursing for the service, which CPT anointed with a new code set in 2006. So coders may wonder why they should put forth the time and effort to correctly code these services.
 
But leaving these codes off the claim could be a mistake because some insurers have started paying for moderate sedation, says Robert LaFleur, MD, of Medical Management Specialists in Grand Rapids, Mich.
 
-Reimbursement for moderate sedation has been spotty,- LaFleur concedes. But he goes on to say that some payers have started paying for certain types of moderate sedation.
 
And Medicare designated these codes as -carrier priced- to gather utilization and proper pricing information. -Many Medicare carriers are beginning to recognize moderate sedation,- says Michael Granovsky, MD, CPC, president of MRSI, a coding and billing company in Woburn, Mass. So although you may not get paid every time you report moderate sedation, you should include it on the claim when you-re allowed to.
 
Benefit: The more times an insurer sees moderate sedation codes on claims, the more likely it will consider paying for the service in future policy decisions.
 
If you are confused about coding for these services, check out this primer on the ins and outs of moderate sedation coding.
 
Use 99143-99145 When Physician Performs Procedure, Sedation
 
There are two sets of moderate sedation codes, which are separated based on the number of physicians involved.

You-ll choose from one of these codes when the same physician performs the sedation and the procedure (or service), says Cheryl Tereba, a manger of revenue recovery for UMass Memorial Healthcare in Worcester:

 - 99143 -- Moderate sedation services (other than    those services described by codes 00100-01999)    provided by the same physician performing the    diagnostic or therapeutic service that the sedation    supports, requiring the presence of an independent    trained observer to assist in the monitoring of the    patient's level of consciousness and physiological    status; younger than 5 years of age, first 30 minutes   intra-service time

 -  99144 -- - age 5 years or older, first 30 minutes intra-service time

 -  +99145 -- - each additional 15 minutes intra-service time (list separately in addition to code for  primary service).
 
Remember: When using moderate sedation codes, you must be sure the medical record contains a thorough explanation of the medical necessity for performing this sedation service. Don't Code Separately for Establishing IV When providing moderate sedation, you cannot report the following services separately:

 -  Patient assessment (not included in intraservice time)

 -  Establishing IV access and fluids to maintain   patency, when performed

 -  Administration of [...]