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Conscious Sedation by Surgeon

  1. #1
    Default Conscious Sedation by Surgeon
    Medical Coding Books
    Does anyone have feedback on how this should be coded?
    "Versed with local, conscious sedation administered and monitored by the surgeon"
    Thanks!

  2. #2
    Default
    The conscious sedation codes are 99143-99150. I am not too familiar with these codes and are currently researching to see if we can bill. We do the billing for the physician's and the hospital is billed seperately. We were always told we could not bill for this because the nurses are administoring the drugs and they are employed by the hospital but our auditor is saying we can. Not really sure what is what in reagards to this. But that is the series for the codes.

  3. #3
    Default
    I would like more information also. We do a few consious sedation's for under age patients when treating fractures. Does anyone know the billing criteria for this as to whom should bill ??

    Thanks in advanced !!

  4. #4
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    The patient is an adult - I am questioning this because of the words "monitored by the surgeon". I would have used 99144 but the CPTdescription says "requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status".
    Does the surgeon's statement preclude the use of this code? There is no mention on the op report of anyone else present and/or assisting...
    Also, is mod 47 used in conjunction with the conscious sedation codes when administered by the surgeon performing the procedure???
    Very confused - all input is greatly appreciated!!!
    Last edited by annr420; 08-04-2009 at 05:47 PM.

  5. #5
    Location
    Charm City - Baltimore
    Posts
    103
    Default
    I coded for pain management docs who wanted to use the concious sedation code (99144). Our docs indicated that even though there was a nurse watching the patient and monitoring them, that they performed the procedure. I first didn't use a modifier, then after a few denials I tried using Mod. 26, but Medicare began denying this code and when they did pay them they later retracted the money considering it a bundled service.
    Crystal, CPC, CCS-P

  6. #6
    Default
    What if the patient if brought from one clinic to ER to perform consious sedation in order for that clinic to do a procedure. Ex a 5 year old patient dislocates their elbow and the Ortho doc send's them to ER for consious sedation and then performs a reduction. It's two seperate physician's billing so it shouldn't be bundled.

  7. #7
    Default
    Quote Originally Posted by CrysLednum View Post
    I coded for pain management docs who wanted to use the concious sedation code (99144). Our docs indicated that even though there was a nurse watching the patient and monitoring them, that they performed the procedure. I first didn't use a modifier, then after a few denials I tried using Mod. 26, but Medicare began denying this code and when they did pay them they later retracted the money considering it a bundled service.
    What pain management code were you using along with the consious sedation ? We are havig issue's with our 62311 injection's and an outside auditor told us we should be billing consious sedation along with the injection code. We disagree but are still researching the issue.

  8. #8
    Location
    Charm City - Baltimore
    Posts
    103
    Default
    We didn't use it on 62311 - mainly on the RF injections (64622 / 64626) and some 64483 codes. I had also heard other coders saying consultants recommended billing for it, but it was a huge struggle for payment.
    Crystal, CPC, CCS-P

  9. #9
    Default
    I work in an ASC so I can't bill for the MAC codes but there has been more discussion on this issue from Medicare and other carriers recently as I've been reading about it again. Arizona has an LCD that's pretty specific with Medicare. I would check into any Medicare LCDs in your area for some guidance. My LCD was just revised eff 7/1/09 and there are guidelines for Medicare payment.

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