Pulmonology Coding Alert

Use intraservice time and patient age to determine which of the 6 codes you should report

CPT has eliminated conscious sedation (CS) codes 99141-99142 for 2006 and replaced them with six time-based codes (99143-99150). The new codes allow your pulmonologist to be in charge of sedation during a procedure, such as a bronchoscopy, but will not allow you to bill separately for the sedation, unless your physician has to use CS during a procedure that usually does not require it.

This could reap additional reimbursement with certain insurers that separate these services, says Denae M. Merrill, CPC, coder for NEM Pulmonary Associates in Saginaw, Mich.

Patient Age Is Now a Factor
 
For 2006, CPT contains six new codes to describe conscious sedation. CPT divides the codes into two groups based on whether the same physician is providing CS and performing the procedure (99143-99145), or whether one physician is overseeing the sedation in support of a second provider who is performing the procedures (99148-99150), Merrill says.
 
Here are the new codes and their descriptors:

• 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; under 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)

• 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; under 5 years of age, first 30 minutes of intra-service time

• 99149--...age 5 years or older, first 30 minutes intra-service time

• +99150--...each additional 15 minutes intra-service time (list separately in addition to code for primary service).

Because CS is now a "time-based" and "aged-based" service, the physician must document the time CS began and ended, as well as the patient's age--in addition to the type and dose of medication (for instance, "1 mg Versed").

How It Works 

You should report 99143 for the first 30 minutes of CS to a patient under 5 years of age if the same physician provides both the CS and the primary procedure. Report 99148 for the first 30 minutes of CS to a patient under 5 years of age if your physician provides CS in support of a different physician who performs the primary procedure.

Similarly, report 99144 for the first 30 minutes for a patient 5 years or older if the same physician administers the CS, or 99149 if a different physician provides the CS.

Note: Codes 99145 and 99150 are "add-on" procedures. You would only report 99145 in addition to 99143-99144 if the physician delivers in excess of 30 minutes of CS. By the same token, you should report 99150 with 99148-99149 for each additional 15 minutes beyond the first 30 minutes that a second physician administers CS, Merrill says.

In addition: Remember that the existence of a CPT code does not guarantee payment. As these new codes take effect, keep a watchful eye on the insurers' responses to them. They may develop internal edits that exclude separate payment for those services, or further restrict their use.