Part B Insider (Multispecialty) Coding Alert

Published on Fri Feb 08, 2013 PDF

Question: Our provider administers epidural steroid injections and pain pump trials in his office procedure room. He’s asking about using PO anesthesia instead of IV sedation. I’m having trouble finding information and whether payers even reimburse for oral medications. What are our options? 

Answer: If the same provider who performed the epidural steroid injection (ESI) and pain pump trials is administering sedation for the pain procedures, you’ll typically report the appropriate moderate sedation code(s). Your choices include: 

99143 — Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; younger than 5 years of age, first 30 minutes intra-service time 

• 99144 — age 5 years or older, first 30 minutes intra-service time 
• +99145 — each additional 15 minutes intra-service time (List separately in addition to code for primary service) 
• 99148 — Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; younger than 5 years of age, first 30 minutes intra-service time 
• 99149 — age 5 years or older, first 30 minutes intra-service time 
• +99150 — each additional 15 minutes intra-service time (List separately in addition to code for primary service). 

Note: Keep in mind that, according to the American Society of Anesthesiologists (ASA), “the majority of minor pain procedures, under most routine circumstances, do not require anesthesia care other than local anesthesia.”