1073358
Expert
Can a PA bill conscious sedation? Also, where can I find documentation of this?
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Wiki Can a PA bill conscious sedation?
- Thread starter 1073358
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mbort
True Blue
is this for a procedure in which conscious sedation is not already bundled into? Please explain the scenario.
marvelh
Expert
Look to the code descriptions for 99143 - 99150, the term "physician" is specifically used.
When these codes were explained at the AMA CPT meeting in late 2005, the anesthesiologist that presented on this code set, stated that the term physician was used in the CPT code descriptions to indicate specifically a physician, i.e. doctor and not a non-physician provider.
The following is from the CPT Assistant May 2006 issue:
Question: Would it be appropriate to report codes 99148-99150 if performed by a qualified health care professional (eg, Nurse)?
AMA Comment: From a CPT coding perspective, codes 99148-99150 apply only to a physician and not a "qualified health care professional." These codes are intended for the second physician. If a qualified health care professional is performing these services, then codes 99143-99145 should be reported.
When these codes were explained at the AMA CPT meeting in late 2005, the anesthesiologist that presented on this code set, stated that the term physician was used in the CPT code descriptions to indicate specifically a physician, i.e. doctor and not a non-physician provider.
The following is from the CPT Assistant May 2006 issue:
Question: Would it be appropriate to report codes 99148-99150 if performed by a qualified health care professional (eg, Nurse)?
AMA Comment: From a CPT coding perspective, codes 99148-99150 apply only to a physician and not a "qualified health care professional." These codes are intended for the second physician. If a qualified health care professional is performing these services, then codes 99143-99145 should be reported.
codegirl0422
Expert
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I am unsure about conscious sedation but for other procedures, you can look under the RBRVS under assistant at surgery, if it has a 0 under it, means:
99148 has a 0 under it:
None (0) = Payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical
necessity
the other indicators 1 and 2 mean, if you ever see them:
Excluded (1) = Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid.
Allowed (2) = Payment restriction for assistants at surgery does not apply to this procedure. Assistant at surgery may be paid.
I code for some PA's that assist surgeries at a hospital. Medicare will not pay when there is a 0 or 1 indicator under assistant at surgery column. I have tried appealing some with indicator 0, but have unsuccessful.
I hope this helps. The RBRVS spreadsheet can be found on CMS's website. For Cahaba (AL, GA) it can be found on their website under fee schedules.
99148 has a 0 under it:
None (0) = Payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical
necessity
the other indicators 1 and 2 mean, if you ever see them:
Excluded (1) = Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid.
Allowed (2) = Payment restriction for assistants at surgery does not apply to this procedure. Assistant at surgery may be paid.
I code for some PA's that assist surgeries at a hospital. Medicare will not pay when there is a 0 or 1 indicator under assistant at surgery column. I have tried appealing some with indicator 0, but have unsuccessful.
I hope this helps. The RBRVS spreadsheet can be found on CMS's website. For Cahaba (AL, GA) it can be found on their website under fee schedules.