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ED moderate sedation

Taylor Posted Fri 22nd of November, 2019 12:50:54 PM
For the ED MD, can moderate sedation times be calculated using the RN documentation of the MD’s time at bedside/sedation given and time left bedside? Thank you.
SuperCoder Answered Mon 25th of November, 2019 04:51:08 AM

Hi Taylor,

As moderate sedation is a work of qualified providers to administered, Certified Registered Nurse Anesthetists (CRNAs), Anesthesiologists, Other Physicians, Dentists, and Oral Surgeons are qualified to provide the sedation. Specifically trained Registered Nurses may assist in the administration of sedation. Because patients can slip into a deep sleep, proper monitoring of sedation is necessary. Healthcare providers monitor patient heart rate, blood pressure, breathing, oxygen level and alertness throughout and after the procedure. The provider who monitors the patient receiving sedation should have no other responsibilities during the procedure and should remain with the patient at all times during the procedure.

However, moderate sedation is a part B covered service, with administration by the physician performing the procedure. Moderate sedation is not a hospital outpatient or ASC clinical staff service, so the coding/billing is done by doctor as a professional fee. It is the physician work related to moderate sedation. The registered nurse under supervision may push the drugs but that person's cost is part of facility fee. Hence, total time can be taken from the nurse note when doctor is off or on bedside.

Hope this helps!

Taylor Posted Mon 25th of November, 2019 11:06:01 AM
Just to clarify... provided 10-22 minutes of moderate sedation time took place, may the ED MD assign an E/M-25, cpt 99152, using the time from the RN's documentation of when the ED MD was at the bedside/med given and left the bedside or does the ED MD need to document his/her own time spent in their dictation? thanks!
SuperCoder Answered Tue 26th of November, 2019 04:24:30 AM

Hi Taylor,

Since, the moderate sedation is covered under a part B service, the sedation must be administered by the physician who performing the actual procedure. Also, sedation is not a hospital outpatient clinical staff service, so the coding and billing for the services need to be done for doctor as a professional fee.

However, the registered nurse under supervision may push the drugs but the cost of that nurse is part of facility. So, total time can be taken of sedation with note of supervision by doctor. Also, make sure that both (physician and nurse) are not billing for the same service at the same time. It is also suggested to check your specific payer policy for the payment patter, if any.

Hope this helps!

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