Anesthesia Coding Alert

Question: One of our anesthesiologists refilled a programmable pump (96530, refilling and maintenance of implantable pump or reservoir) for one of our pain patients. He did sedate the patient, and the procedure was quite laborious because of patient circumstances. A pain nurse was present during the procedure. The patients insurance carrier will reimburse for 96530 at a very low rate. Is this a situation where I could bill for conscious sedation, which would have higher reimbursement?

Mississippi Subscriber

Answer: Conscious sedation (99141, sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) is intended to be in addition to the procedure, not in place of it. Codes 99140 (anesthesia complicated by emergency conditions [specify]) and 99141 provide for physician administration and qualified attendant monitoring during a patients procedure. However, Medicare and most insurance carriers do not pay for either code because they consider them to be bundled into the procedure. Some insurance carriers will pay for conscious sedation, although they may have certain requirements for it. For example, a trained observer must be present to monitor the patient throughout the procedure. It is recommended that this person complete a form separate from the physicians, noting vital signs and other monitoring to substantiate that he or she was involved in the procedure. The physician who administers the sedative must document the sedation, dosage, type, etc., as well as the medical necessity for it.