Neurology & Pain Management Coding Alert

CPT 2006 gives you expanded options for managing young patients

In the new year, you will need to follow suit with CPT 2006 and delete conscious sedation from your coding options. If you use sedation to keep a patient still during an MRI or CT, you-ll need to report your services using a new time-based family of codes. Get Cozy With the New Codes Beginning Jan. 1, you will no longer be able to report codes 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) or 99142 (-oral, rectal, and/or intranasal). In their place, the CPT update introduces a new group of services under the term -moderate sedation,- but don't let the new name confuse you.

Moderate sedation is the same service that you previously reported as conscious sedation. It is a relaxed state of consciousness that is achieved by administering medication intravenously or orally. Individuals are awake, but drowsy, and able to maintain their airways and ability to respond to stimulation or verbal commands. Neurologists will sometimes use sedation to keep patients still, especially children, for certain procedures. 

Turn to these codes to report moderate sedation in 2006:

- 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; under 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 intra-service time (list separately in addition to code for primary service)

- 99148--Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician other than the healthcare professional performing the diagnostic or therapeutic service that the sedation supports; under 5 years of age, first 30 minutes of intra-service time

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

- +99150---each additional 15 minutes intra-service time (list separately in addition to code for primary service). Account for Additional Time While conscious and moderate sedation are essentially the same procedure, how you report this service will require some adjustments for 2006. Instead of coding your surgeon's anesthesia services based on administration method, you will soon choose the proper code based on the patient's age, the providing physician(s), and total -intra-service- time.

CPT 2006 spells out how you should start and stop the clock to properly record for this service, and you need to make sure you keep an eye on these three elements:

1.  Start recording intra-service time when the physician administers the sedation agent.
2.  Document continuous face-to-face attendance.
3.  Stop intra-service time when the providing physician ends personal contact. Remember: Just like with the old sedation codes, the guidelines for moderate sedation require the services of an -independent trained observer- monitoring [...]