Moderate Sedation

jlmcelroy1

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I am unable to find clear written guidance regarding moderate sedation. My question is when coding moderate sedation do you pick up the HCPCS J codes for the medications used to induce the sedation?

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RonMcK3

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Billing moderate sedation?

Does the procedure in question include moderate sedation? Was it administered by the physician performing the procedure? If so, isn't the cost of the anesthetic agent also included and therefore not billable, like other supplies incidental to a procedure?

CPT 2012 Appendix G in its directions provides that moderate sedation is billable when administered by a different physician from the health care professional performing the procedure.
 

jlmcelroy1

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Yes the code does include moderate sedation and the provider performing the procedure is the one that is providing the sedation.

The problem I am having is I agree that the anesthic agent would be included but some of my providers disagree. I was looking for soemthing in writing that would state either way.

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dwaldman

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If this is in a setting where you are responsible for billing for the drug I believe that you could bill the drug separately from 99144/99145 for example.
 

RonMcK3

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What anesthesiologist?

dwaldman,

As I understand the facts, there is no anesthesiologist. The physician performing the procedure is administering the moderate sedation for a procedure identified in App G as Includes Moderate Sedation. Since there is no anesthesiologist**, CPTs 99144/99145 are N/A as I understand it. (** or separate physician administering the moderate sedation)

So, since administration of the moderate sedation is included in the procedure, does it follow that the cost of the agent used for the moderate sedation is also covered by the billing for the procedure and is not separately billable?
 

dwaldman

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Now I see what the scenario is but I don't believe the CPT manual or CPT Assistant states not to bill for a drug, They might state the procedure is considered inclusive but I am leaning towards that does not prevent the reporting of the drug itself. Sorry I didn't originally read the following responses and additional questions close enough.
 
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