Cardiology Coding Alert

Question: Can we bill sedation codes 99144-99145 with peripheral atherectomies and stents? What does the cardiologist need to have in his documentation? Kentucky subscriber Answer: Yes. Beginning Oct. 1 (and retroactive to Jan. 1, 2006), you can bill sedation codes (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 ...) with peripheral atherectomies (35490-35495), peripheral stents (37205-37206), and other common cardiology procedures. Keep in mind: If your cardiologist does a plasty in conjunction with any of these services, the conscious sedation is a component to the PTA/plasty. Also, if the cardiologist does conscious sedation with cardiac procedures, you should not report the sedation. The catch is that you have to document the time. You'll choose your code based on time intervals, so the cardiologist must document when the sedation begins (when the physician begins the sedation drugs) and ends (when the physician concludes personal contact with the patient). Also, a trained observer must be with the patient. Keep in mind: In your CPT book, you'll see cardiology codes with the 8 symbol next to them (they're also listed in Appendix G). This means that you cannot report these codes with moderate sedation. For more information, look at MLN Matters Number: MM5618 available at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5618.pdf.