Pulmonology Coding Alert

Question: How does moderate sedation work in pulmonology?

New Mexico Subscriber

Answer: If your physician provides both a procedure and moderate sedation, the general rule is you won't report the sedation separately. When you see a "dot inside a circle" next to a procedure code in your CPT® manual, you'll know that you shouldn't report moderate sedation separately with that procedure. Commonly, these procedures include bronchoscopies (31622-31629, 31635, 31645, 31646, and 31656), catheter insertion and tube thoracostomy (32550, 32551).

Alternative: How should you report a scenario when the patient does not require sedation for a procedure (i.e., bronchoscopy) that includes moderation sedation? CPT® specifically states that you need not append modifier 52 (Reduced services) to the procedure even if the patient was not moderately sedated. In short, you will not gain extra reimbursement for providing CS, but neither will your payment decrease if you don't administer this service.