Neurosurgery Coding Alert

Question: I've heard rumors that CPT will begin bundling conscious sedation to spinal taps, as well as MRIs, CT scans and other tests. Is this true? Our surgeon sometimes uses conscious sedation for younger or hard-to-manage patients.


New York Subscriber


Answer: The rumors aren't true, but they have some basis in fact.

CPT does not bundle conscious sedation to spinal taps (62270, Spinal puncture, lumbar, diagnostic; or 62272, Spinal puncture, therapeutic, for drainage of cerebrospinal fluid [by needle or catheter]), nor does it bundle the procedure
to magnetic resonance imaging (MRI) or computed tomography (CT) scans at this time.
 
However, Appendix G of CPT 2005 now states that conscious sedation, as described by 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) and 99142 (...oral, rectal and/or intranasal), is an inherent component of over 250 codes, including many surgical procedures (although none immediately relevant to neurosurgery practice).

CPT clearly states, "Since these services include conscious sedation, it is not appropriate for the same physician to report both the service and one of the conscious sedation codes," and also clarifies, "The provision of conscious sedation by the operating physician includes the oversight of personnel who are monitoring the patient."

Be careful to note that regardless of CPT's instructions, Medicare has disallowed separate payment for conscious sedation since 1998. In other words, Medicare won't pay for conscious sedation in 2005, but it wouldn't do so prior to 2005, either. However, private or third-party payers should still allow you to bill 99141 if you have done so in the past.

Be sure not to confuse conscious sedation (which requires a trained independent observer working alongside the physician) with sedation, which does not require an observer.

You can view a complete list of the codes affected by the conscious sedation bundles in Appendix G of CPT 2005 or the AMA's CPT Changes 2005 - An Insider's View.  - Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery.