Wiki Documentation Request

[nsteinhauser]

I'm not familiar with CRNA billing and if anyone out there could point me to some documentation, I'd sure appreciate it. Anesthesiologists perform ESI's in our ASC. A Medicare patient had an ESI performed by the anesthesiologist and a CRNA administered conscious sedation. Typically sedation is not used with these. Are there any NCD's or other CMS materials out there that explain coverage (or lack thereof) of conscious sedation when administered by a different provider - in this case the CRNA? I checked the contractor's site - in this case NGS - and came up with the pain LCD but can't find anything that addresses coverage for sedation. Thanks in advance.

 

[hgolfos]

You can bill moderate sedation with this procedure. There is documentation in the RVG put out by the ASA on pages 46-47 which discusses the differences between MAC and moderate sedation.

I searched for a moderate sedation LCD/NCD on the CMS website and came up empty; however, we have never had issue getting paid for moderate sedation by Medicare. Our pain clients use an RN to administer the meds and monitor the patient and bill 99144 & 99145. If your CRNA's are billing they would just use the 99149 & 99150 codes for other provider.

Hope this helps.