SEDATION SERVICES BILLING — PART 1

Coding and Billing for sedation services tend to cause confusion for providers that are not accustomed to such billing practices. Services such as tumescent, anoxiolysis, and moderate sedation get mixed up with the codes that are out there for general anesthetic services. For clarity, these services have specific definitions and attendant work requirements and/or certification requirements associated with their billing guidelines.

 

To understand what is or is not separately reportable, one must understand the concept of Global Surgical Package. In brief, this means that any services that are inherently necessary to perform a surgical procedure are included in the payment for that procedure. This includes intraoperative services, as well as some before and after care.

 

Tumescent or local anesthesia, always used in varicose ablative procedures is never separately reportable from the surgical service itself. There is no CPT code to report tumescent, and it is always considered inclusive in the global surgical package. Refer to the CPT definition of services included “local infiltration; digital block; or topical anesthesia”.

 

Inhalation agents have come into question recently as using nitrous oxide gains attention. Currently there are no reportable codes for this service outside of Dental procedures. Because of its definition as minimal sedation, it also is not appropriately reportable under general anesthesia codes 00100-01996. Current coding rules state it may not be separately reportable from the procedure, but if it was to be billed it would need to be under an unlisted code 01999 or if a particular payer requires, the dental code D9230. However, don’t be surprised if a denial is received for the service code being considered integral to the primary procedure, or experimental and investigational.

 

Moderate Sedation has new codes this year under 99151-99157, deleting the old codes of 99144 and 99145. The common codes for phlebology are 99152 and 99153. There is a change to the reporting times in these codes from “first 30 min” under 99144 to “first 15 minutes” under 99152. CPT has also gone on to add a very clear definition of what is and is not reportable, and what exactly comprises preservice, intraservice, and postservice work requirements. They have also added a sample time table explaining how to track and report by time.

 

Deep sedation, general anesthesia, or monitored anesthesia care are billed under codes 00100-01966. General anesthesia is described as “a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug induced depression of neuromuscular function. Cardiovascular function may be impaired”.

 

The difference between General anesthesia and deep sedation is in the following description:  “a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully  following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.”

 

Both services require a patient to be depressed beyond the levels described in moderate sedation and would not be expected to be used in conjunction with phlebology procedures.

 

A more in depth article detailing Moderate Sedation regulations and billing will be sent in next month’s edition of Phlebology News.

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