Wiki Cardiologist Injected Patient With Propofol During TEE

[bcousey26]

I need assistance regarding as to rather our cardiologist can billed for the injection of the propofal.

He performed a TEE and injected the patient with propofal with from what I gather is considered GA. According to the CPT manual 93312 includes moderate sedation.

From the information I received the propofal can only be administered by a CRNA or a licensed anesthesiologist in order to be billable. Someone suggested that I use

93312-47 and
00520-P1

I'm confused because the P1 modifier is only for anesthesiologist usage only. Can anyone clarify this?

 

[Michele Hannon]

The use of Propofol does not constitute a general anesthetic. The following is the ASA (American Society of Anesthesiologists) definition of general anesthesia.
General Anesthesia is a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.

The ASA also has a position statement regarding the safe use of Propofol. Propofol use is not restricted to anesthesia providers.

In this case, was the patient intubated with a secure airway? What documentation is provided regarding monitoring and propofol administration (bolus vs infusion) and patient level of un/consciousness?
These will all impact your decision.

 

[bcousey26]

Thank you for the much needed clarification!