Wake Up to Differences between Conscious Sedation and Anesthesia Codes
Published on Fri Feb 01, 2002
Emergency department coders often say they are in a quandary about how to correctly report procedures that involve conscious sedation and anesthesia. CPT includes codes and definitions exclusively for conscious sedation, as well as procedure codes that allow for anesthesia during specific services. However, contradictory definitions of what constitutes anesthesia abound, causing confusion about when to report conscious sedation services as opposed to codes that refer to "with anesthesia." Reimbursement policies also vary wildly from payer to payer, adding to the bafflement of professional coders.
Understanding Conscious Sedation
Most clinicians and coders agree on what constitutes conscious sedation. In short, CPT defines conscious sedation as a medically controlled state of depressed consciousness while maintaining the patient's airway, protective reflexes, and ability to respond to stimulation or verbal commands. Generally speaking, conscious sedation is used when performing painful or long procedures (e.g., during laceration repair, orthopedic stabilizations, etc.). It may also be used when children or the elderly are treated, because they often have lower tolerance to pain. For coders to assign conscious sedation codes, they must ensure that the medical record includes performance and documentation of pre-, intra- and postsedation evaluations of the patient, administration of the sedation and/or analgesic agent(s), and monitoring of cardiorespiratory function (i.e., pulse oximetry, cardiorespiratory monitor, and blood pressure). Conscious sedation is an invaluable procedure in the emergency department. However, it is not anesthesia, and this has created controversy complicated by varying payer policies governing how it is paid.
According to Cindy McMahan, CPC, an independent coding consultant based in Albany, Wisc., conscious sedation is reported with one of two codes, depending on the method of administration:
99141 sedation with or without analgesia (conscious sedation); intravenous, intramuscular or inhalation
99142 ... oral, rectal and/or intranasal.
"CPT has implemented very clear coding guidelines that govern the use of the conscious sedation codes," McMahan says. "The requirements include that the sedation be administered by the physician performing the procedure, and that an independent, trained observer be present to assist the physician in monitoring the patient's level of consciousness and physiological status."
The definition of independent, trained observer, she adds, indicates that a designated individual, other than the performing physician, should be responsible for monitoring the patient during the procedures performed with sedation and, when appropriate, analgesia. "This individual, often a registered nurse, should be able to recognize complications, and be capable of establishing a patient airway and positive pressure ventilation," McMahan says. The observer should also maintain advanced life support skills and be prepared to summon additional assistance if necessary.
McMahan adds that payer policy regarding conscious [...]
