Correctly Code for Conscious Sedation in the ED
Published on Mon Mar 01, 1999
When performing delicate and painful procedures on children, the elderly, and some other adults in special situations, ED clinicians often employ a service known as ?conscious sedation? to facilitate the performance of the procedure with a minimum of discomfort to the patient and the physician.
For example, a parent brings in a young child with a facial laceration requiring several stitches. Certainly, an analgesic will be given so that the child won?t feel the pain of the sutures; but in many cases, the physician will also want the child to be sedated so that he or she won?t move during the delicate procedure.
?You would want to do this with other patients as well. Elderly patients who present with dislocated shoulders, for example, or people who are mentally challenged who just aren?t going to understand you coming at them with needles,? adds John Stimler, DO, FACEP, a practicing emergency physician in Jacksonville, FL, and a past president of the Florida chapter of the American College of Emergency Physicians.
Correct coding for the administration of conscious sedation is challenging for many ED coders primarily because reimbursement varies from payer to payer. In addition, this procedure requires several different clinical services, medications, and significant documentation that the coder must recognize in order to bill these services as ?conscious sedation.?
What Is Conscious Sedation?
Separate from medication to prevent pain, conscious sedation is the administration of drugs that will put the patient in a lower state of consciousness, but will not put them ?all the way under? as with the use of general anesthesia during surgery.
CPT defines conscious sedation as ?sedation with or without analgesia to achieve a medically controlled state of depressed consciousness while maintaining the patient?s airway, protective reflexes, and ability to respond to stimulation or to verbal commands.?
Drugs used to induce conscious sedation vary depending on the patient and the procedure being performed, says Stimler. Intravenous administration of medications (99141-sedation with or without analgesia [conscious sedation]; intravenous, intramuscular, or inhalation) is used more for dislocations and fracture reductions, he adds. The medications most commonly used would be Versed, morphine, meperidine hydrochloride (Demerol), or fentanyl.
?Ketamine is more commonly used in the pediatric age group and is usually given by injection,? he adds.
Oral medications are usually given to older patients or children who need to be very still for a CAT scan or MRI; chloral hydrate is the most common agent in these instances, says Stimler. Code 99142 is used for ?oral, rectal and/or intranasal? drug administration.
Performance of conscious sedation requires that these drugs be administered in the presence of a trained observer besides the ED physician (who is often the ED nurse), and that the patient?s blood pressure, cardiac rhythm and respiration be monitored.
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