Wiki HELP PLEASE! IV Pushes with Moderate Sedation

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elshelton

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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!!
 
Howdy! Please see the copied information below for resource:

CPT codes 96360-96379, 96401-96425, and 96521-96523 are reportable by physicians for services performed in physicians' offices. These drug administration services should not be reported by physicians for services provided in a facility setting such as a hospital outpatient department or emergency department. Drug administration services performed in an Ambulatory Surgical Center (ASC) related to a Medicare approved ASC payable procedure are not separately reportable by physicians. Hospital outpatient facilities may separately report drug administration services when appropriate. For purposes of this paragraph, the term “physician” refers to M.D.'s, D.O.'s, and other practitioners who bill Medicare claims processing contractors for services payable on the “Medicare Physician Fee Schedule”

I take this to mean that drug infusions are non payable in relation to ASC procedures that are payable, in your case I believe the answer is no.
 
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