Wiki HELP PLEASE! IV PUSHES BILLED WITH MODERATE SEDATION

[elshelton]

Can everyone please let me know you thoughts on billing IV pushes (96374) for versed and fentanyl (J2250, J3010), while billing moderate sedation (99152) with the drugs for moderate sedation being the fentanyl and versed for say a lumbar facet nerve block (64493), or lumbar RFA (64635). From what I pull with CCI edits I say no we should not apply a 59 modifier to by pass the edits but I have another saying yes we should bill with a 59. Please give me the rationale if I am wrong. Am I over looking something? Thank you for all your help it is greatly appreciated!! 5/3/2021 This is still an issue. I need back up for my case does any one else in pain management have any feed back I can add to my case?

 

[dnostdahl]

@elshelton We always just bill the MAC codes and the drug codes even though the Drug codes pay very little. We never used the 59 modifier in Pain Mgmt for anything.

 

[SharonCollachi]

I think this footnote from the American College of Cardiology covers the issue - it's not separately billable:

Additional Coding Tips For Moderate Sedation​

• Codes 99151- 99157 are not used to report administration of medications for pain control, minimal sedation, deep sedation, or monitored anesthesia care (00100-01999)
• An independent trained observer is an individual who is qualified to monitor the patient during the procedure, who has no other duties (i.e., assisting at surgery) during the procedure
• Codes 99151- 99157 include pre, intra, and post-service work associated with MS services

 

[elshelton]

Thank you!

 

[elshelton]

This is still an issue. I need back up for my case does any one else in pain management have any feed back I can add to my case?