AAPC - Back to school
Results 1 to 2 of 2

Thread: Minimal vs Moderate Sedation

  1. #1
    Join Date
    Apr 2007
    St. Joseph County, Indiana

    Default Minimal vs Moderate Sedation

    AAPC: Back to School
    This thread goes out to everyone in Indiana, Michigan, Ohio and New York...the states that I know where physicians who perform anesthesia in their office need to be accredited.

    In Indiana, physicians must be accredited if they perform 'moderate' sedation. No accreditation is needed for 'minimal' sedation. I work with many pain management physicians who perform procedures in an office-based procedure room, and (surprise) there does not seem a consensus on what is 'minimal' and what is 'moderate'.

    The Indiana law stipulates that minimal sedation/anxiolysis" means a drug-induced state during which a patient responds normally to verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are usually not affected.

    "Moderate sedation/analgesia" (also sometimes called "conscious sedation") means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation.
    The following are conditions that a patient under moderate sedation may experience:
    (1) No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate.
    (2) Cardiovascular function is usually maintained.

    In most situations, pt's are given IV Versed or Fentanyl under the direction of the pain specialist. Pt's walk out of the procedure room on their own after their procedure/sedation.

    Questions: Both Fentanyl and Versed affect respiration and cardiovascular functions. However, in small doses the affect is small. Can small doses of Versed/Fentanyl still be minimal sedation? What is small? If you read the definition of 'minimal' one way, it sounds like only things like oral Valium would be allowed. If IV sedation can be considered 'minimal', where is the line and how would we document it? How do you document "normal" versus "purposeful" conversation...other than 'normal' versus 'purposeful'?

    The only thing at stake is $15,000, hundreds of man hours and six months of delay.

    Your assistance is greatly appreciated.

  2. #2


    I found an article by the ASA to be very informative on the subject of recognizing levels of sedation and definitions of moderate sedation. I don't believe the dose amount is the determining factor, because it may take a small amount for one person while another may require a larger dose to obtain the same effect. The determining factor is level of consciousness. This article is dated 2002, but it is the latest guidance that the ASA gives on the subject.


    Hope it helps,

Similar Threads

  1. Moderate Sedation in ED
    By acraven12 in forum Emergency Department
    Replies: 1
    Last Post: 08-21-2014, 10:23 AM
  2. moderate sedation
    By jalderson in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 07-18-2013, 12:06 PM
  3. Moderate sedation
    By alysn1drlnd in forum Outpatient Facilities
    Replies: 0
    Last Post: 06-27-2013, 10:22 AM
  4. minimal sedation
    By renifejn in forum Anesthesia
    Replies: 1
    Last Post: 02-04-2009, 05:30 AM
  5. Moderate Sedation
    By sp485 in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 08-22-2008, 05:26 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.