Pulmonology Coding Alert

Question: A bronchoscopy is performed using sedation. Can the physician bill for the sedation or is that covered under the facility billing?

Nebraska Subscriber

Answer: The Medicare fee schedule precludes payment of a separate fee for anesthesia when it is provided by the same physician performing the medical/surgical procedure or by his or her staff. It is considered a bundled service, and payment for the bundled service is included in that for the bronchoscopy. In other words, reimbursement for the anesthesia is included in the global surgical period.

Sometimes separate payment for sedation is allowable when performed by a physician other than the one performing the procedure. You should check with each insurer because this payment may vary.

Answers to You Be the Coder and Reader Questions were provided by Carol Pohlig, BSN, RN, CPC, at the University of Pennsylvania department of medicine in Philadelphia; Mary Mulholland, RN, BSN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania's department of medicine in Philadelphia; and Walter J. O'Donohue, MD, FCCP, founding chairman of the CPT committee of the American College of Chest Physicians (ACCP) and a representative to the AMA CPT advisory committee for ACCP.