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Consious sedation codes

  1. #1
    Default Consious sedation codes
    Medical Coding Books
    Is there anyone out there w/ experience in billing for bone marrow biopsies done using consious sedation? My issue is that we are seeing bone marrow biopsies done and provider will keep a vitals/IV record of the administration of Versed/midazolam, and will bill out the 99144 and 99145 codes, and when I've contacted nursing staff, they've told me what they are doing is giving the med in an IV push form of less than 1min. What exactly should I be looking for in the documentation as far as being able to bill out the 99144 (1st 30 min of C.S) if they are giving it as an IV push? Does this not have to be an IV of at least 30 min to bill out for this code? If anyone could help w/ some input I would greatly appreciate it. Thanks!

  2. #2
    Default
    There should be a sedation record that shows the time sedation started when it was stopped, when the patient went into recovery, it should also show monitoring of the patient vitals etc, and the administration of Versed/midazolam.

  3. #3
    Default sed record
    Okay, so this is where I'm having a problem and I've contacted nursing staff and even they aren't clear on what they are telling me. I am able to find the sed records here is an example of what one looks like:
    7/19/10- 14:29- IV Solution: Normal Saline- BP 151/68 mmHG- Pulse 86 -SpO2 93%- Other Medications: Midazolam 2 mg given

    7/19/10- 14:41- IV Solution: -- - BP 154/76 mmHg- Pulse 92 pt up and talking- SpO2 95%-Other Medications: --

    7/19/10- 14:48- IV Solution: -- - BP 155/69 mmHg- Pulse 92- SpO2 99%
    Other Medications: Midazolam 3 mg given

    7/19/10- 14:53- IV Solution: -- - BP 144/60 mmHg- Pulse 90- SpO2 96%-
    Other Medications: --

    7/19/10- 14:56- IV Solution: -- - BP 135/75 mmHg- Pulse 90- SpO2 98%
    Other Medications: --

    We are having problems deciphering this sedation record and I have spoke w/ several different nurses about this. For this example record the MD billed out the 99144 x 2. I spoke w/ a nurse and she said they do IV pushes for the administering of this drug, so how am I to determine how long the consious sedation is? 99144 is for the 1st 30 minutes... If they are doing an IV push of this drug is it really correct to bill the 99144?

  4. #4
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Quote Originally Posted by lisalinsley View Post
    Okay, so this is where I'm having a problem and I've contacted nursing staff and even they aren't clear on what they are telling me. I am able to find the sed records here is an example of what one looks like:
    7/19/10- 14:29- IV Solution: Normal Saline- BP 151/68 mmHG- Pulse 86 -SpO2 93%- Other Medications: Midazolam 2 mg given

    7/19/10- 14:41- IV Solution: -- - BP 154/76 mmHg- Pulse 92 pt up and talking- SpO2 95%-Other Medications: --

    7/19/10- 14:48- IV Solution: -- - BP 155/69 mmHg- Pulse 92- SpO2 99%
    Other Medications: Midazolam 3 mg given

    7/19/10- 14:53- IV Solution: -- - BP 144/60 mmHg- Pulse 90- SpO2 96%-
    Other Medications: --

    7/19/10- 14:56- IV Solution: -- - BP 135/75 mmHg- Pulse 90- SpO2 98%
    Other Medications: --

    We are having problems deciphering this sedation record and I have spoke w/ several different nurses about this. For this example record the MD billed out the 99144 x 2. I spoke w/ a nurse and she said they do IV pushes for the administering of this drug, so how am I to determine how long the consious sedation is? 99144 is for the 1st 30 minutes... If they are doing an IV push of this drug is it really correct to bill the 99144?
    The 30 minutes is not dependent upon how long it takes to administer the drugs used for the conscious sedation. In my experience, these are usually a push. It is not like infusion or hydration. Per CPT Assistant, February 2006, "the intraservice time starts with the administration of the sedation agent(s). It requires continuous face to face attendance and ends at the conclusion of personal contact by the physician providing the sedation." Recovery time cannot be counted toward the 99144 time.

    So, from the time the sedation was administered until the physician was done with the procedure and the patient was transferred to recovery, that is the time you count for conscious sedation.

    Hope that helps,
    Last edited by cmcgarry; 08-20-2010 at 03:47 PM. Reason: corrected spelling
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  5. #5
    Default
    Thanks alot! Yes this does help

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