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Gastroenterology Coding Alert

READER QUESTIONS:

Rules Vary on Conscious Sedation With EGD

Published on Sun Jul 10, 2005

Question: Can we get paid separately for conscious sedation administered during an upper gastrointestinal endoscopy (EGD)? A woman with severe, persistent pain in her upper-right abdomen reported to our gastroenterologist. The gastroenterologist performed an EGD with intravenous conscious sedation to alleviate the woman's  pain, but I am not sure whether I should report the sedation.


South Dakota Subscriber


Answer: Whether you report the sedation depends on the carrier. Medicare will not reimburse for conscious sedation during an EGD, so do not try with any of its carriers.

For Medicare payers, you should:
 

  •  report 43248 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with insertion of guidewire followed by dilation of esophagus over guidewire) for the EGD.
     
  •  link 789.01 (Abdominal pain, right upper quadrant) to 43248 to represent the patient's pain.

    With private payers, you may be able to gain payment if your contract calls for conscious sedation payment when the physicians uses it during an EGD. First, find out if your carrier accepts conscious sedation codes in this type of encounter.

    If the carrier accepts the codes with EGD codes, then you should:
     
  •  report 43248 for the EGD
     
  •  report 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) for the sedation.
     
  •  link 789.01 to 43248 and 99141 to account for the patient's abdominal pain.

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