Moderate Sedation

[hadwyer7]

I work in an cardiology physician's office. Our providers perform cath procedures at the hospital as well as in our office. We were told that we should be billing the moderate sedation when it was performed in the hospital and are starting to receive denials. We are needing some clarification on these codes.

1. We were told that it can be performed by an RN and we can still bill this under the physician's name.
2. We were told to bill it for the hospital as well. (won't this cause double billing though due to the hospital billing for their services?)

Our providers never administer the moderate sedation it is always typically an RN. We have been using 99152 but are now wondering if we should have been using 99156. But if we use 99156 pretty much all of our procedures we bill state you cannot bill 99156. I know these are newer codes but hoping someone has better insight.

Thanks!
Heather CPC, CCC

 

[thomas7331]

I'm not versed in the usage of these particular codes, but in any case, physicians may never bill for services performed by nurses in a hospital setting. This is considered 'incident to' billing and is only allowed in the physician's own office. The hospital must bill for services performed by their employees. A physician can only bill for what they personally perform in the facility.