Orthopedic Coding Alert

Question: We recently treated a dislocated shoulder while we had the patient under conscious sedation. We reported the "dislocation treatment without anesthesia" code (23650) and the conscious sedation code (99141), but our physician thinks we should have just reported the "shoulder dislocation treatment with anesthesia" code (23655) instead. Who is right? Alaska Subscriber Answer: You are. According to the AMA's 2001 CPT Coding Companion, "Codes listed in the musculoskeletal system that state 'requiring anesthesia'mean general anesthesia." Because you administered conscious sedation and not general anesthesia, you should report 23650 (Closed treatment of shoulder dislocation, with manipulation; without anesthesia) and 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation).

Remember that you can report the 99141-99142 conscious sedation code series only if the surgeon administers the conscious sedation. A note in CPT states that if someone other than the surgeon administers conscious sedation, he or she should report a code from the anesthesia section. You Be the Coder and Reader Questions were reviewed by Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopaedic Associates in New Brunswick, N.J.