Wiki Moderate (conscious) sedation

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rjburd68

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Should we be billing out the CPT codes for moderate sedation for our interventional radiologists if they are not the ones administering it to the patient? Another qualified person in the room is the one who does the administration and remains there as the independent trained observer. Is there any documentation or news articles that support the decision to code the sedation codes by the IR radiologists? We are aware of Appnedix G and what codes include the sedation.
Thank you,
Rob Burd, CPC
Casper Medical Imaging
 
Rob, As an Ambulatory Surgical Center I am not allowed to bill that UNLESS it is OUR supplies, OUR employee, and not on the list of included in the appendix. Usually for me there is an Anesthesiologist or the Physicians employee in the room doing the sedation. I know this probably does not help much.

Kris Miskimins, CPC, CASCC
Casper Surgical Center
 
Also, to be more detailed, our IR doctors are doing these procedures at the hospital and not here at the OPR facility. So in their documentation, they do say that the moderate sedation was administered but they don't say by whom. Plus they say monitored by a critical care nurse for the entire procedure. In the past, they have documented that they are the ones administering the sedation (rarely) and we did bill for that.
But now we are at a crossroads of do we or don't we and they want to know why we haven't billed any for 2011. For some reason a few months ago, we saw something somewhere that said if the IR person did not administer it, then we can't code for it. But of course we cannot find that piece of information anywhere.
Anymore advice is greatly appreciated.
Thanks,
Rob
 
Rob, I also found this from CPT ASSISTANT dated 2009,

November 2009 page 11-end
Appendix G: Moderate Sedation, 99143-99145, 99148-99150 (Q&A)

Question: How is moderate sedation reported with codes not listed in Appendix G when performed by the same physician in a nonfacility (eg, physician office, freestanding imaging center) setting?

Answer: The services listed in Appendix G include moderate sedation as an inherent part of providing the procedure, thus, it is not appropriate for the same physician to report both the procedure and the moderate sedation codes, 99143-99145. The guideline in Appendix G indicates the following, "Since these services include moderate sedation, it is not appropriate for the same physician to report the service and the sedation codes 99143 -99145." This statement refers to the procedure codes listed in Appendix G, and does not limit the reporting of other procedure codes that are not included on this list when services are provided by the same physician in conjunction with codes 99143 - 99145. Table 1 is intended to further illustrate the rules for reporting the moderate sedation codes.

Table 1: Reporting Rule* for Moderate Sedation Codes
Codes Appendix G
Facility Appendix G
Nonfacility Not in Appendix G
Facility or Nonfacility
99143-99145
Trained observer No No Yes
99148-99150
Physician services Yes No Yes


*Third-party payers may have specific reporting guidelines and you may wish to contact your individual third-party payers for specific reimbursement/payment policy guidelines.


--------------------------------------------------------------------------------

Appendix G: Moderate Sedation, 99143-99145, 99148-99150 (Q&A). CPT® Assitant. 2009; November 2009 page 11-end

Kris Miskimins, CPC, CASCC
Casper Surgical Center
 
Great, thank you.
I guesss it all comes down to is if our IR person is the one providing the sedation himself to the patient or if someone else is.
Do we code the 99144, + 99145 (time dependent) for our IR doctor doing the actual IR procedure no matter who administers the sedation?
 
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