Wiki Ketamine Billing in Facility by Provider

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beckmanj

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Marana, AZ
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I have a provider that does Ketamine Infusion with propofol anesthesia in a facility setting. He is with the patient directly for the three hour infusion time period monitoring the patient himself. Based on the CPT guidelines we cannot use the infusion code 96365 and the add on codes that follow it because it states: "These codes are not intended to be reported by the physician or other qualified health care professional in the facility setting". How can we bill it correctly? Can we bill based on Moderate Sedation? E/M? Anybody else do this?
 
Our doctor is an anesthesiologist. He does Conscious Sedation and stays with the patient throughout the procedure. The pre-assessment with conscious sedation is included with it. Can he bill for the conscious sedation?
 
anesthesia w/ infusion done in a facility by physcian

I have a case where our anesthesiologist provided the MAC sedation for a 14 yo patient w/ severe autism (violent outbursts), chiari malformation and autoimmune deficiency, while the IV Infusion of Gammagard was done. My MD stayed with the patient, monitoring, charting, etc for the full 4 + hours of infusion as prescribed by the patients PCP. The service was provided in the PACU of the hospital. I want to use the 96365 but there isn't a crosswalk. Would using 01999 be appropriate in this case, while sending all documentation available? I think the unusual circumstance of this case would meet the medical necessity, but am looking for confirmation from others. Has anyone else dealt with this?
 
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