Neurology & Pain Management Coding Alert

Question: Our neurologists bill for conscious sedation of children during MRIs, CT scans, etc., with anesthesia codes such as 01922. Is this a valid approach for reimbursement?

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Answer: Code 01922 (anesthesia for non-invasive imaging or radiation therapy) is used to bill a general anesthesia procedure in which the patient is totally unconscious and is not appropriate for conscious sedation.

Sedation with or without analgesia (conscious sedation) is used to achieve a medically controlled state of depressed consciousness while maintaining the patients airway, protective reflexes and ability to respond to stimulation or verbal commands. Conscious sedation includes performance and documentation of pre- and post-sedation evaluations, administration of sedation and/or analgesic agent(s), and monitoring of cardiorespiratory function (i.e., pulse oximetry, cardiorespiratory monitor, and blood pressure). The use of these codes requires the presence of an independent, trained observer to assist the physician in monitoring the patients level of consciousness and physiological status.

Codes 99141 (sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) and 99142 (... oral, rectal and/or intranasal) should be used to report this procedure when the neurologist also performs the primary procedure (such as MRIs and CT scans). Confusion has arisen as a result of the CPT 2001 instruction, If the sedation with or without analgesia is administered in support of a procedure provided by another physician, see the anesthesia section.

This instruction is primarily meant to address anesthesiologists who are only providing the conscious sedation for a neurologist. In the event that a neurologist was performing it for another physicians primary procedure, licensing rules and regulations and scope of practice (which may vary from state to state for neurologists) need to be considered to determine if it is permissible for a neurologist to bill an anesthesia code.