Wiki Conscious Sedation

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10marty

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One of my cardiologists seems to think that he can bill for conscious sedation during a TEE and Cardiac caths. I am under the impression that this can not be done. In the CCI edits it appears that the conscious sedation codes still have a 0. Is there any new information out there that I may not be aware of?

Thanks
 
First of all, if he is doing the TEE's and cath's in the outpatient hospital setting (which I certainly hope that is the location) then he is not the one providing the conscious sedation, it is the nurse in the procedure room so he cannot code for it.
 
Lisa,

Thank you for your timely response. When I shared this info with my cardiologist he states that other cardiologists are billing conscious sedation while doing peripherals. In CCI under code set 36245-36247 i don't see any bundling issues. Is he correct? I still feel this is the same issue as cardiac cath's, TEE's, etc.

Marty
 
Marty - I am with you. There is no difference, especially if being done in the outpatient hospital setting. I may be wrong, but unless your surgeon is actually administering the conscious sedation, he should not be billing for it. The conscious sedation codes have no RVU's and modifier -47 as far as I am aware, does not increase the allowed amount for a procedure. I tried to paste a link to Cigna's policy but you have to have a log in. It basically states that conscious sedation is included in the surgical package.
 
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Lisa,

Thank you for your timely response. I appreciate your input. What would you do in this situation? I will try and see if I can pull the Cigna Policy. Do you think contacting my local medicare carrier would be worth the effort?

Marty
 
Hi Marty - you could at least try. We do not charge for the conscious sedation because the hospital provides the nursing staff that gives the sedation and moniters the patient. I'd be interested in what you find out though.
Lisa
 
Sedation codes

Please look in Appendix G of your CPT book, it shows you all of the codes that include conscious sedation. No you cannot code and bill for it, per cpt guidelines.
 
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