Part B Insider (Multispecialty) Coding Alert

Published on Wed Jun 20, 2007 PDF

Second doctor collaborating on sedation is best bet

Myth: Medicare won't ever pay for new moderate sedation codes 99143-99145 and 99148-99150.

Reality: These codes, which came out in 2006, are -carrier-priced.- That means it's up to the Part B carriers to decide whether to cover them, and how much to pay. And the good news is many carriers have started reimbursing these codes.

The codes have been around for about 18 months now, but carriers started to pay for them about nine months ago, according to Michael Granovsky, a physician and president of MRSI, a coding and billing company in Woburn, MA. Carriers reimbursing these codes include Empire, WPS and Palmetto, he says.

Details: There are actually two sets of moderate sedation codes, Granovsky notes. You use 99143-99145 when the same physician performs a procedure and also puts the patient under moderate sedation. You-d use 99148-99150 when one physician performs the procedure and another physician sedates the patient.

Many carriers are currently only paying for 99148-99150, the codes for a second physician performing moderate sedation, according to Marvel Hammer with MJH Consulting in Denver, CO. At least one carrier has been covering 99143-99145 as well, however.

Note: CPT codes 99143 and 99148 are for children under the age of five. And 99144 and 99149 are for the first 30 minutes of sedation for anyone five and older. 99145 and 99150 are add-on codes for each additional 15 minutes.

Write to your carrier and request coverage for moderate sedation. Your letter should explain that moderate sedation -requires a certain level of provider skill and training, as well as medical legal liability,- says David McKenzie, CAE reimbursement director with the American College of Emergency Medicine. Also, moderate sedation leads to greater patient satisfaction, better outcomes, and lower cost than anesthesia in the operating room.
You should also explain that the RVU Update Committee (RUC) surveyed several specialty societies to come up with work RVUs for these codes. You can find these on page 70282 of the Nov. 21, 2005 Federal Register.

So far, most carriers seem to be reimbursing these codes at close to RUC-recommended levels, says Granovsky.