Conscious Sedation in ASCs
Published on Sun Dec 01, 2002
Most gastroenterologists use conscious sedation during ambulatory endoscopies but find that receiving reimbursement for this form of anesthesia is difficult at best.
Many carriers' general guidelines regarding conscious sedation also apply to ambulatory surgical centers. Considering that the use of the conscious-sedation drug propofol is growing in popularity, you may have several questions regarding coding for this service in your practice. Medicare's Policy for ASCs The Medicare Carriers Manual states that coverage of ASC services includes not only the surgery but also "services furnished in an ASC in connection with a covered surgical procedure which are otherwise covered if furnished on an inpatient or outpatient basis in a hospital in connection with that procedure." This does include materials for anesthesia: the anesthesia itself and any materials needed for its administration. ASC policy holds true to existing policy regarding surgeries performed in hospitals. If a physician usually charges a global surgery fee, then this same approach is used when a physician performs the same procedure in an ASC.
The issue of anesthesia directly affects you because several gastrointestinal endoscopies require anesthesia, whether general anesthesia or conscious sedation. Included in this category are the upper gastrointestinal endoscopies (43235) and colonoscopies (45378-45387). Billing for Propofol There are unresolved issues regarding the anesthesia used in many of the ambulatory gastrointestinal endoscopies. Conscious sedation is the most common type of sedation used for these procedures. This type of sedation is preferred because it is "used to achieve a medically controlled state of depressed consciousness while maintaining the patient's airway, protective reflexes, and ability to respond to stimulation or verbal commands," according to CPT guidelines . Drugs most commonly used for conscious sedation include meperidine (Demerol), diazepam (Valium), and midazolam (Versed). These are included in the analgesic category of anesthesia drugs.
However, a second group of drugs is gaining notoriety: anesthetic induction agents, including such drugs as ketamine (Ketalar) and propofol (Diprivan). Pat Stout, CMC, CPC, an independent gastroenterology coding consultant and president of OneSource, a medical billing company in Knoxville, Tenn., says that propofol is becoming popular because it can be used without the after effects of other drugs. For example, the wake-up period is shortened, the need for transportation is often skipped, and time is saved in the recovery room.
But gastroenterologists are facing some problems with the use of propofol. There is a question as to whether propofol is conscious sedation or not, Stout says. This question does not have a general answer, since many states differ in their local policies. If it is classified as general anesthesia, an anesthesiologist has to give it. The issue with [...]
