Wiki Documentation for Conscious Sedation

[giajo]

Does any one know where I can find specific rules for the proper documenation of conscious sedation? I have a doctor that I code for that is questioning whether or not the specific drug used needs to be documented. The CPC book isn't very clear when it comes to the drug documentation.

 

[mbort]

One would think that the doc would want to document what he used for legal purposes. If he is administering conscious sedation he should ALWAYS indicate in his know what he is administering to sedate the patient. What if the patient has a drug reaction? (sorry I dont know where to find the documentation, I think that this is a common sense issue).