Pulmonology Coding Alert

Question: If a physician who administers conscious sedation while another physician performs an emergency procedure, can he bill critical care for the time instead of conscious sedation? 99291or 99149?

Michigan Subscriber

Answer: A physician should only report the code that represents the services provided. CCI edits bundle moderate (conscious) sedation into many procedures when administered by the performing physician (or two physicians of the same specialty in the same provider group). Per CPT, moderate sedation is a drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Patients require no intervention to maintain an airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. Moderate sedation does not include minimal sedation (anxiolysis), deep sedation or monitored anesthesia care (00100-01999).

When providing moderate sedation, include the following services and do not report separately:

• Assessment of the patient (not included in intraservice time);
• Establishment of IV access and fluids to maintain patency, when performed;
• Administration of agent(s)
• Maintenance of sedation;
• Monitoring of oxygen saturation, heart rate and blood pressure; and
• Recovery (not included in intraservice time).

When a second qualified physician (different group and specialty) other than the healthcare professional performing the diagnostic or therapeutic services provides moderate sedation in the facility setting (e.g., inpatient hospital/outpatient hospital/ambulatory surgery center,) for the procedures listed in Appendix G, the second physician reports 99148-99150 (Moderate sedation services [other than those services described by codes 00100-01999]...). These services are carrier-priced after the services are determined to be medically necessary. However, for the circumstance in which these services are performed by the second physician in the nonfacility setting (e.g., physician office, freestanding imaging center), you would not report codes 99148-99150.