ED Coding and Reimbursement Alert

If you have been coding for your ED physician's moderate sedation service while another provider performs a procedure, the Correct Coding Initiative (CCI) just put a stop to it.

CCI 15.3, effective Oct. 1, bundles these sedation services into many ED-relevant procedure codes in the books. Check out this guidance on which moderate sedation codes are out, which ones are still in, and how to tell the difference.

The following codes have been bundled into most procedure codes you'd see in the ED:

• 99148 -- Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician 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

• 99149 -- ... age 5 years or older, first 30 minutes intra-service time

• +99150 -- ... each additional 15 minutes intraservice time List separately in addition to code for primary service).

The basics: The bundles for 99148-+99150 have a 0 modifier, which means you cannot unbundle the sedation under any circumstances , explains Caral Edelberg CPC, CCS-P, CHC, president of Medical Management Resources for TeamHealth in Jacksonville,than the [provider] performing the procedure," Edelberg says. If your physician does provide moderate sedation service while another physician performs a procedure, you might be able to code an E/M (99281-99285) service if the history, physical exam, and medical decision making documentation support it.

Check with your carriers before doing this, as it "is very state- and payer-specific," warns Edelberg.

Don't Assume All Moderate Sedation's Out

While CCI won't allow ED providers to code 99148-+99150, it does still allow for some moderate sedation in the ED.

The CCI edits state, "Medicare rules allow physicians performing a surgical or diagnostic procedure to separately report medically reasonable and necessary moderate conscious sedation with a procedure, unless the procedure is listed in Appendix G of the CPT Manual."

So if your physician performs the procedure and the sedation, you might be able to report one of the following moderate sedation codes:

• 99143 -- 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; younger than 5 years of age, first 30 minutes intra-service time

• 99144 -- ... age 5 years or older, first 30 minutes intra-service time

• +99145 -- ... each additional 15 minutes intraservice time (List separately in addition to code for primary service).

Best bet: After this edit, be certain you're in line with each payer. Make sure your coding conforms to each insurer's policy by double-checking your CCI edits, and your payer contracts, before coding 99143-+99145. For more information on CCI 15.3, check www.cms.hhs.gov/NationalCorrectCodInitEd.