moderate sedation question

Karen Powell

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I work for an ER physician group and I have been billing the 99144 codes when documented properly. I was told recently by an Anesthesiologist that I can't code moderate sedation if our doctor is doing the procedure and the sedation. I checked on MCR website and I have found information that this code is up to insurance discretion on how much they will pay on this code. I couldn't find anything on my state law (Alabama) that states this. Am I right that we can charge for both? I checked the CCI edits and use the moderate sedation with procedures not on the Appendix that says the sedation is included. Shouldn't this be enough proof for my doctors because now everyone is questioning my answer? I still think I am right. PLEASE HELP THANK YOU
 

dmaec

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if CCI edits says it's included, then you shouldn't bill separately. Did you look at both Column 1/Column 2 and Mutually Exclusive edits?
{that's my opinion on the posted matter}
 
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Karen I believe that if the procedure code being billed does not have any edits hitting on it and you are in the ER then yes he can bill moderate sedation. I work for mulitple work comp carries and if the documentation supports and no edits hit then we allow it. However, we dont see it that often. If I remember correctly, we had one that billed for dislocated shoulder and we did allow the sedation to reset the shoulder.
 
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