Radiology Coding Alert

Medicare reimbursement may still be just a dream

If your patients commonly require sedation to help them get through radiology procedures, watch out--your coding options for this service have undergone some important changes in 2006.

“We often use conscious sedation for patients prior to cardiac catheterizations and other interventional procedures to reduce anxiety,” says Carrie Caldewey, CPC, an experienced radiology coder and coding supervisor for Northern California Medical Associates in Santa Rosa, Calif.

What to do: For these sedation services on or after Jan. 1, delete 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) and 99142 (…oral, rectal, and/or intranasal) from your reporting in accordance with CPT Codes 2006.

In place of these codes, the updated CPT manual introduces a new family of services under the term “moderate sedation,” but don’t let the new name confuse you. Moderate sedation is the same service that you previously reported as conscious sedation--a drug-induced depression of consciousness that allows patients to maintain their airways and ability to respond to stimulation or verbal commands.

Use these codes to report moderate sedation in 2006:

• 99143--Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician 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; under 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 other than the healthcare professional performing the diagnostic or therapeutic service that the sedation supports; under 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). Oust Administration Type as Reporting Criterion While conscious and moderate sedation are essentially the same procedure, how you report these services will require some adjustments for 2006. Instead of coding your radiologist’s sedation services based on administration method, you will now choose the proper code based on the patient’s age, the providing physician(s), and total “intra-service” time. (See “Knock Out ‘Intra-Service’ Time Confusion for MS Codes” later in this issue).

Coding basics: When your radiologist is serving [...]