Part B Insider (Multispecialty) Coding Alert

Published on Thu Oct 19, 2006 PDF

You can't bill for E/M codes separately unless you can justify a modifier

So far, no Medicare carriers have decided to pay for new moderate sedation codes 99143-99149. (See PBI, Vol. 7, No. 8.) But just in case that changes, the Correct Coding Initiative Version 12.1 makes 107 codes into components of those codes starting April 1.

Bundled: As of April 1, you'll need a modifier to bill for moderate sedation along with any of the evaluation & management codes.

You'll also need a modifier if you want to bill for moderate sedation with: intracatheter introduction code 36000, venipuncture codes 36400-36410 and 36420-36425, hydration codes 90760, almost all of the new injection codes, and cardiography codes 93000-93010 and 93040-93042.

But you won't be able to use a modifier to override edits bundling moderate sedation with local anesthetic code 01995 or pulse oximetry codes 94760-94761. You will be able to override edits bundling moderate sedation codes with continuous overnight monitoring code 94762.

Moderate sedation codes 99143-99144 also become components of 543 codes each. These include 270 codes from the anesthesia section of the CPT book, 73 codes from the respiratory and cardiovascular surgery sections, 16 cardiovascular therapeutic services codes, and 48 codes from the cardiac medicine section.

Components of 99143-99144 also include surgical endoscopy codes 43200-43272, 44360-44500 and 45303-45392. You can't use a modifier to override any of those edits.

Not much hope: All of these new edits don't necessarily mean that Medicare plans to start paying for moderate sedation, laments Margaret Loftus with Stanford Hospital & Clinics. These codes have no relative value units (RVUs) and Medicare has given them Status C, meaning carrier-priced. "These services were historically considered bundled and I see nothing yet that indicates they have changed their minds," Loftus says.

Many other procedures that involve conscious sedation don't include the costs of conscious sedation in their RVUs, but carriers deny them anyway, says Carrie Ontiveros, coding specialist with the Wichita Clinic in Wichita, KS. "CPT guidelines specifically outline which services include conscious sedation," she adds. But physicians who perform those services "are basically providing a free service."