Anesthesia Coding Alert

Question: Our anesthesiologist used fentanyl and propofol to provide sedation during a child’s intrathecal chemotherapy. The oncologist is billing 96450. Should we bill 00635 or 99148 for the sedation?

Massachusetts Subscriber

Answer: Although your anesthesiologist administered sedation, that doesn’t mean you automatically report 99148 (Moderate sedation services [other than those services described by codes 00100-01999], provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; younger than 5 years of age, first 30 minutes intra-service time) or other moderate sedation codes.

As you see in the descriptor for 99148, the moderate sedation codes are for situations not covered by anesthesia codes 00100-01999. That means an anesthesiologist should report the applicable anesthesia code for sedation instead of 99148.

The surgeon plans to report 96450 (Chemotherapy administration, into CNS [e.g., intrathecal], requiring and including spinal puncture). This crosses to anesthesia code 00635 (Anesthesia for procedures in lumbar region; diagnostic or therapeutic lumbar puncture), base value of 4. You should submit 00635 with the applicable number of time units for your physician’s sedation services.