Wiki Conscious sedation 99144 - Our docs in Pain Management

[shegge]

Our docs in Pain Management charge for 99144 in an ASC setting, primarily 2 mg of IV Versed preoperatively. I understand the reasoning but have always wondered why the physician charges 99144 and I assume the ASC charges as well due to an RN doing the monitoring...................

can the ASC and the doc charge for the conscious sedation? I have researched and found conflicting answers.

What do you think? Thanks in advance.

Shelly

 

[dwaldman]

I believe the physician is reporting the conscious sedation because he is the one providing it with the trained observer.

https://www.cms.gov/Medicare/Medica...egulations-and-Notices-Items/CMS-1633-FC.html

If you look at the Medicare ASC fee schedule, it is important to note that CPT 99144 is not a payable code on the ASC side. Additionally, HCPCS code J2250 is not separately payable for Medicare per addendum BB.

Similarly, in hospital setting for Medicare any form of anesthesia is considered packaged into the APC payment that falls under the CPT or HCPCS code that is reported.


Addendum BB -- Final ASC Covered Ancillary Services Integral to Covered Surgical Procedures for CY 2016 (Including Ancillary Services for Which Payment is Packaged)

J2250 Inj midazolam hydrochloride N1

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From a Medicare perspective, reviewing the above link or looking at the ASC fee schedule for the Medicare contractor that you bill, if CPT 99144 is not payable then that would also exclude Medicare advantage plans such as Care Improvement, Humana Gold Plus, etc...
I would assume Medicaid carrier you are billing is not separately paying for conscious sedation as a facility fee in the ASC.
So that would leave you with the private payers and their interpretation of this when billed on a UB-04.