Radiology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
  Question: When is it appropriate to bill conscious sedation for radiology procedures? I know Medicare usually does not reimburse for this will other insurers? What about a situation such as an MRI, when the patient cannot complete the exam without some sedation? Florida Subscriber                               Also, note that these codes are exempt from use of modifier -51 (Multiple procedures). Codes for pulse oximetry (94760-94762) may not be reported with these conscious sedation codes because they are inclusive components of the sedation procedure. Conscious sedation codes can be used in conjunction with codes for procedures that commonly include a provision for conscious sedation. It is frequently administered during interventional procedures as well as pediatric procedures.

You simply need to make sure that the "sedation be administered by the physician performing the procedure and that an independent trained observer be present to assist the physician in monitoring the patient's level of consciousness and physiologic status," according to CPT guidelines. If the conscious sedation is administered by someone other than the physician, the anesthesia codes need to be used. In all cases, careful documentation is the key. The issue of coverage, however, is an entirely different story. Medicare refuses to pay for conscious sedation when provided and/or overseen by the same physician who is providing the procedural service, assuming that the sedation service is bundled into the primary procedure. When dealing with a Medicare patient, only bill for the procedure and the sedation drug, not the conscious sedation service. For private carriers, code for the sedation procedure unless it is contractually excluded. Some private carriers pay, but others still refuse, and the patient must generally be billed for the sedation if an insurance denial is received from a commercial payer.   Answer: Conscious sedation is a sticky issue for coders, considering that insurance coverage of this service is sporadic at best. However, there are certain guidelines to follow when attempting to get payment for conscious sedation. You should always ask your specific payers for their policy on coverage for this service. Conscious sedation (99141-99142) is "sedation with or without analgesia [and] is used to achieve a medically controlled state of depressed consciousness while maintaining the patient's airway, protective reflexes and ability to respond to stimulation or verbal commands," according to CPT Codes . In the past, many insurance carriers have limited coverage of anesthesia and analgesia to anesthesiologists or nurse anesthetists. These conscious sedation codes, however, allow other physicians to report this service. [...]