Anesthesia Coding Alert

Question: A physician wants to charge for administering conscious sedation to children during MRIs, CT scans, bone marrow biopsies and Botox injections. Medicaid tells me that the code I want to use (99141, Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) is bundled into the procedure. What can you recommend for billing conscious sedation successfully with other carriers?

Georgia Subscriber  
Answer: Most insurance carriers ignore conscious sedation and/or modifier -47 (Anesthesia by surgeon). The codes for conscious sedation (99141, which you mention, and 99142, oral, rectal and/or intranasal) are designed for surgeons rather than anesthesiologists because the surgeon usually provides conscious sedation during the procedure. If the anesthesiologists services are requested for the procedure, document the request in writing along with the reason for it (e.g., the procedure is being performed on a child). If the anesthesiologist provides sedation during the procedure, it is often considered monitored anesthesia care (MAC) and is coded with modifier -QS (Monitored anesthesia care service) with 01922 (Anesthesia for non-invasive imaging or radiation therapy). You could also append modifier -23 (Unusual anesthesia) and include documentation to justify its use.