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Moderate Conscious Sedation in ED determined by Drug Used?

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karencurto

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Does the drug used determine whether to code as moderate conscious sedation or anesthesia? According to ASA it is not the drug but rather the level of consciousness. ED provider is performing the sedation as well as the procedure requiring it. I am being told that if Propofol is used in this scenario (dr has documented MCS) that we would code the cpt code for the procedure “with anesthesia”.
 
karencurto said:
Does the drug used determine whether to code as moderate conscious sedation or anesthesia? According to ASA it is not the drug but rather the level of consciousness. ED provider is performing the sedation as well as the procedure requiring it. I am being told that if Propofol is used in this scenario (dr has documented MCS) that we would code the cpt code for the procedure “with anesthesia”.
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Who is telling you that and what are their resources to back up that statement?
 
A clinical person who is basing it on Propofol being an anesthetic. I have found references from ASA and ASGE that indicate specifically that it is not the drug because drugs such as Propofol or Versed can be used for very light or very deep sedation - it is the level of consciousness
 
I agree with you, you cannot use the drug itself to determine the type of anesthesia that is used.

With regard to CPT code assignment, there are some good articles in CPT Assistant that might help with this, for example the article from January 2018 on Fracture and dislocation restorative services, which states that "For purposes of coding, use of local anesthetics is not considered "anesthesia" because local infiltration is always part of the surgical package.

Some of the CPT codes specify in their descriptions what level of anesthesia meets that requirement (e.g. 21073 which states "requiring an anesthesia service (ie, general or monitored anesthesia care)" or 69424 - Ventilating tube removal requiring general anesthesia) whereas others simply state "with/under/requiring anesthesia" (e.g. 20693, 20694), which per my understanding would imply any anesthesia other than local.

I don't have access at the moment to the latest editions so there may some guidance more current than this, but hopefully this helps some.
 
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