Anesthesia Coding Alert

Considering the heavy focus on moderate sedation in the latest round of Correct Coding Initiative (CCI) edits, every coder should be up to date on when -- and how -- to correctly report moderate sedation services. By  focusing on the providers and documentation of their roles, you'll be on your way to claims success.

It's easy to confuse the various levels of sedation your physician might provide, so start with the basics:

• Anesthesiologists don't provide moderate sedation. As the American Society of Anesthesiologists (ASA)points out, "It is important to note that anesthesiologists provide anesthesia (0XXXX codes) services. The moderate sedation codes were developed for cases where nonanesthesiologist physicians sedate patients" (December 2005 ASA newsletter).

• Your physician might provide moderate sedation under different circumstances. "When an anesthesiologist is performing a nerve block/injection procedure, he or she is classified as the 'surgeon,'" says Joanne Mehmert, CPC, CCCPM, ACS-PM, of Joanne Mehmert and Associates in Kansas City, Mo. Once your provider shifts from an anesthesia provider role to the provider (or surgeon) performing the service, you're in the realm of moderate sedation.

• You still need a qualified independent observer present in addition to the physician completing the service. The same physician cannot safely sedate the patient, monitor his or her condition, and perform the diagnostic or therapeutic service. Another qualified observer must be present during the procedure to monitor the patient and assist in sedation services.

• Moderate sedation does not include minimal or deep sedation. "CPT makes it clear that the moderate sedation codes are for sedation other than those described by the anesthesia codes," says Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla. "Moderate sedation does not include minimal sedation (anxiolysis), deep sedation, or monitored anesthesia care (MAC)."

CPT divides moderate sedation codes into two families. "Both sets of codes are then further broken down based on the age of the patient and incremental time," Mac says.

• If the same physician provides moderate sedation and performs the procedure, choose from 99143-+99145 (Moderate sedation services [other than those services described by codes 00100-01999] provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status ...). For example, pain management providers  often report 99144 in conjunction with injection procedures such as radiofrequency destruction 64622-64627 (Destruction by neurolytic agent, paravertebral facet joint nerve ...).

• If different providers perform the service and oversee the moderate sedation, code from 99148-+99150 (Moderate sedation services [other than those services described by codes 00100-01999], provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports ...) instead. You could possibly report these codes in addition to procedures, such as MRIs or spinal taps for children or other non-Medicare patients (since CCI edits regarding moderate sedation might not affect reporting for non-Medicare cases).

Every detail supporting moderate sedation is crucial, considering how closely payers scrutinize the claims. Keep these final tips in mind before filing:

• Don't report moderate sedation when the procedure code has a bull's eye symbol beside it in the CPT manual (such as 22526-22527 for percutaneous intradiscal electrothermal annuloplasty, or IDET). For a quick look at procedures that include moderate sedation, see Appendix G in your CPT book.

• Because you're dealing with time-based codes, calculate the time correctly. Intraservice time requires the surgeon's continuous face-to-face attendance, Mehmert says. Calculate the time from when the surgeon is present (when the sedation agent is administered) until the surgeon is no longer present. "The nursing records and physician's report of service should document the time that the physician is personally present with the patient," Mehmert adds.

• Assign the correct add-on code when the service lasts longer than 30 minutes. Codes +99145 and +99150 have the same descriptor ending (... each additional 15 minutes intra-service time [List separately in addition to code for primary procedure]), so be sure to match the addon code with the appropriate base code.

• Check with your payer about moderate sedation reimbursement. "Codes 99143-+99150 are still carrier-priced with no relative value units (RVUs) assigned, and there is no change in the proposed Medicare Physician Fee Schedule," Mehmert says. Some payers (such asHighmark Medicare) never allow separate payment for anesthesia service when the same physician furnishes the medical or surgical service. Translation: Payers set their own reimbursement for moderate sedation. Check your Medicare contractor's Web site for information so you'll know what to expect.