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Pediatric Coding Alert

Choose Conscious Sedation or Anesthesiology Codes Appropriately for Optimal Payment

Conscious sedation codes 99141 (intravenous, intramuscular or inhalation) and 99142 (oral, rectal and/or intranasal) are intended to report a service administered by the same physician who is performing the primary procedure. Both codes are modifier -51 (multiple procedures) exempt, meaning the physician providing the sedation can bill it with other procedures and be paid the full fee. When a second physician provides the conscious sedation, however, CPT requires the use of the anesthesia codes (00100-01999). Those pediatricians who perform conscious sedation in support of another physician and bill 99141 or 99142 are forfeiting deserved reimbursement.

Standard of Care Requires Pediatricians Presence

Often, for instance, a radiologist requests that a pediatrician administer conscious sedation for a child undergoing an MRI. Although, technically, the radiologist could perform the sedation, many radiologists as well as hospital administrators concerned about liability believe a pediatrician is better qualified to administer and monitor conscious sedation for a child. Radiologists may not feel comfortable handling an airway emergency especially for a child.

The standard of care is to have someone experienced with a pediatric airway emergency present throughout the conscious sedation procedure, explains Mike Cinoman, MD, director of the pediatric intensive care unit and pediatric inpatient services at WakeMed in Raleigh, N.C. This may be an anesthesiologist, a pediatric intensivist, a pediatric emergency medicine physician or an experienced pediatrician. Nevertheless, the conscious sedation codes clearly allow for a nonphysician (specifically, an independent trained observer) to monitor the patient. The only clear-cut use of the conscious sedation codes for a pediatrician is if the pediatrician administering the sedation is also performing the procedure requiring the sedation, says Joel Bradley, MD, FAAP, editor of the current edition of Coding for Pediatrics and a member of the American Academy of Pediatrics coding and reimbursement committee.

Using the Anesthesia Codes

If a pediatrician provides conscious sedation in support of another physician, he or she can bill an anesthesia code, says Richard A. Molteni, MD, FAAP, CPT editorial panel member. The anesthesia codes can be used by anyone. They are not limited to anesthesiologists, he explains.

The anesthesia codes are arranged according to anatomy. For anesthesia administered during a procedure to the head, for instance, a code should be selected from the 00100-00222 series; for the neck, 00300-00352, etc. Therefore, for conscious sedation delivered while an orthopedic surgeon performs a closed reduction on an ankle fracture, bill 01462 (anesthesia for all closed procedures on lower leg, ankle, and foot).

Subsections within the anesthesia codes also include radiological procedures, burn excisions or debridements, and other procedures. The correct anesthesia code for an MRI, for example, is CPT 01922 (anesthesia for non-invasive imaging or radiation therapy).

Note: When using [...]