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mmagness

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I work for a cardiology practice and one of our physicians wants to bill conscious sedation (99144) with a Peripheral Vascular Study. The doctor does provide the sedation and the PV codes in question are the 36100-36248. Has anyone ever billed this and gotten paid? Are there any practices billing the sedation at all? I appreciate any and all feedback.

Thanks,
MM;)
 
We bill for conscious sedation but payment depends on payor. Our Medicare carrier (Palmetto) just deleted their LCD but other carriers have LCDs in place and only pay based on approved dx. Some commercial insurances pay and others do not. As long as there isn't a bulls-eye next to the surgical code, we always bill for it if it was provided.

Diane Huston, CPC, RCC
 
If you don't mind me asking, how extensive do your doctors dictate on the concious sedation? We haven't billed for it in the past because the doctors have never indicated it in the documentation but one of our physicians would like to. I want to make sure that he dictates everything he needs in order to get proper credit. I know that he would have to indicate the time in order to bill- What additional things should he include? Thanks for all of your help.

MM:)
 
Our dictation states:

"Moderate sedation was employed using Versed and Fentanyl titrated for patient comfort by a trained independent observer. Continuous physiologic monitoring vital signs was performed for approximately 105 minutes"

The extra verbage about the pt comfort and independent observer was required by one of the insurances and follows the description of the procedure in CPT. And more is always better in case you have to appeal.

Diane Huston, CPC,RCC
 
Hello,

Our cardiologists never bill for conscious sedation for any of the procedures they do. Look at the CPT book and at the symbol for moderate sedation. If the symbol appears next to the code then you cannot bill separately for it. I have attended seminars on interventional procedures and I do not recall reading or being told to bill for conscious sedation.

Dolores CPC, CCC
 
Most of the cardiology codes do include the conscious sedation but the original post said a peripheral vascular study was being done so that would involve codes not in the cardiology section and those codes do allow separate billing of conscious sedation.

Diane Huston, CPC,RCC
 
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