| FAQ 1 |
Does CPT still use the term Conscious Sedation ? |
| A |
Starting with the release of the 2006 book CPT has further defined the concept of Conscious Sedation which is now termed Moderate (Conscious) Sedation in an effort to distinguish this service within the spectrum of sedation. Moderate (Conscious) Sedation does not include minimal sedation or anxiolysis, deep sedation or, anesthesia services.
The codes for Conscious Sedation, 99141 and 99142, have been deleted. New codes describing Moderate (Conscious) Sedation have been created within the code series 99143-99150.
|
| FAQ 2 |
What exactly is Moderate (conscious) sedation? |
| A |
Moderate (Conscious) Sedation [MCS], is a drug induced depression of consciousness. The patient maintains the ability to respond purposely to verbal direction or verbal direction either alone or accompanied by light tactile stimulation. Interventions are not required to maintain the patient’s airway. |
| FAQ 3 |
What is included in providing Moderate (Conscious) Sedation? |
| A |
According to CPT, Moderate (Conscious) Sedation includes:
Assessment of the patient, establishment of IV access, administration of agent(s), maintenance of sedation, monitoring of oxygen saturation, heart rate, and blood pressure, and recovery. |
| FAQ 4 |
How is intraservice time defined for the reporting of Moderate (Conscious) Sedation? |
| A |
Intraservice time starts with the administration of the sedation agent(s), requires continuous face to face attendance, and ends at the conclusion of this personal contact by the physician. Assessment of the patient and recovery, once personal contact is concluded, are not included in intraservice time. |
| FAQ 5 |
How are the new codes grouped for Moderate (Conscious) Sedation? |
| A |
Codes 99143-99145 describe Moderate (Conscious) Sedation services provided by the same physician who is also performing the procedure or diagnostic service for which the Moderate (Conscious) Sedation is needed. Codes 99148-99150 describe Moderate Sedation services provided by a physician other than the health care provider performing the diagnostic or therapeutic service for which the MCS is needed. Both sets of codes are then further delineated based on patient age and incremental time. |
| FAQ 6 |
What specific codes are used to report MCS when a single provider is overseeing the sedation and performing the MCS supported service? |
| A |
CPT Code 99143 describes Moderate Sedation provided by the same physician performing the diagnostic or therapeutic service that the sedation supports for patients under 5 years of age for the first 30 minutes of intraservice time.
CPT Code 99144 describes Moderate Sedation provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, for patients over 5 years of age for the first 30 minutes of intraservice time.
CPT Code 99145 describes each additional 15 minutes of intraservice time. |
| FAQ 7 |
What specific codes are used to report MCS provided by one physician in support of a second physician who is performing the diagnostic or therapeutic service? |
| A |
CPT Code 99148 describes Moderate Sedation provided by a physician, other than the health care professional performing the diagnostic or therapeutic service that the sedation supports, for patients under 5 years of age, for the first 30 minutes.
CPT Code 99149 describes Moderate Sedation provided by a physician, other than the health care professional performing the diagnostic or therapeutic service that the sedation supports, for patients under age 5 years of age, for the first 30 minutes.
CPT Code 99150 describes each additional 15 minutes of intraservice time. |
| FAQ 8 |
How would I report 45 minutes of intraservice sedation time provided in support of another physician for a child less than 5 years of age? |
| A |
You would report 99148 for the first 30 minutes of intraservice time and 1 unit of 99150 for the additional 15 minutes. |
| FAQ 9 |
Is Moderate (Conscious) Sedation bundled with or considered an inherent part of any procedures? |
A
|
In CPT 2005 a new policy was created identifying conscious sedation as being
bundled into many procedures. This means the physician performing both these procedures and conscious sedation could not code separately for conscious sedation. This policy has been extended into CPT for Moderate (Conscious) Sedation. Appendix G of CPT 2009 lists several hundred procedural codes which include MCS. Codes bundling MCS are denoted with a target symbol in the CPT book. CPT further instructs, in the circumstances when the patient does not require sedation, the operating physician is not required to report the procedure as a reduced service using modifier 52.
Codes of interest to emergency medicine bundling Moderate (Conscious) Sedation include the following:
31615 Tracheobronchoscopy through tracheostomy
31622 Bronchoscopy diagnostic
32551 chest tube insertion
33010 pericardiocentesis
33210 insertion transvenous pacemaker
36555 insertion pediatric (under age 5) central line
36568 insertion pediatric (under age 5) PICC line
92953 transcutaneous pacing
92960 elective cardioversion
Do not report codes 99143-99145 with procedures listed in Appendix G.
|
| FAQ 10 |
Will MCS be bundled with procedures listed in Appendix G in the scenario where the MCS is being provided by the ED physician in support of a second physician who is performing the diagnostic and therapeutic service? |
| A |
When the Moderate (Conscious) Sedation services are provided in the Emergency Department setting, by a second physician in support of a procedure listed in Appendix G, the moderate sedation service codes 99148-99150 may be reported. |
| FAQ 11 |
Are there any other special requirements for coding Moderate (Conscious) Sedation? |
| A |
The MCS services described by codes 99143-99145 require the presence of an independent trained observer to assist in the monitoring of the of the patient’s level of consciousness and physiologic status. |
| FAQ 12 |
Does Medicare have any specific regulations in respect of Moderate (Conscious) Sedation? |
| A |
National Medicare has reconsidered its payment policy on Moderate (Conscious) Sedation. For 2009, the codes have been assigned a Status Indicator C, meaning they are carrier priced, and do not carry an assigned RVU. Regional Medicare carriers are being encouraged by National CMS to reocgnize Moderate Sedation services. |
