Follow These Deep Sedation Insider Tips

This year, you might be coding more deep sedation services in the ED, thanks to recent changes. Your claims' accuracy will rest on careful documentation of the duration and level of consciousness attained. Read on for expert medical coding advice on modifier use and payer regulations dealing with anesthesia and also what anesthesia CPT codes you must select.

The advent of fresher sedation drugs, mainly propofol, resulted in greater sedation effectiveness and less recovery time for the patient after deep sedation, therefore making the services a better fit in the ED.

Green light from CMS: CMS released a policy clarification in January 2011 that clearly recognized that it is acceptable to CMS for emergency physicians to provide all levels of sedation.

2012 CPT Lookup Tip: To accurately bill these services, you'll need ED providers to document the patient's level of consciousness through all anesthesia services. CPT® guides coders to the Anesthesia Section of CPT® to code deep anesthesia or monitored anesthesia care.

The CPT® Anesthesia section guidelines state that the Anesthesia CPT codes include the usual preoperative and postoperative visits, the anesthesia care throughout the procedure, the administration of fluids and/or blood and the normal monitoring services for instance EKG, temperature, blood pressure, pulse oximetry, capnography and mass spectrometry.

Modifier 47 alert: When coding regional or general anesthesia services delivered by the same physician carrying out the service for which the anesthesia is administered, CPT® directs the use of modifier 47 (Anesthesia by Surgeon), to be appended to the basic service

Heed Time, Patient Status: Cautious reporting of anesthesia time is critical to the coding and documentation of these services. Per CPT®, anesthesia time begins when the physician begins to prepare the patient for the induction of anesthesia and ends when the physician is no longer in personal attendance.

CPT® also instructs to use both the anesthesia CPT code itself and a physical status modifier. These modifiers contain the letter "P' and a number from 1 to 6:

P1: (A normal healthy patient)

P2: (A patient with mild systemic disease)

P3: (A patient with severe systemic disease)

P4: (A patient with severe systemic disease that is a constant threat to life)

P5: (A moribund patient who is not expected to survive without the operation)

P6: (A declared brain-dead patient whose organs are being removed for donor purposed)

Coding example : For a patient going through mild systemic disease getting deep sedation services for a bronchoscopy, the anesthesia portion would be reported as: 00520-P2.

Qualifying circumstances are additional codes to signify specific situations where anesthesia services are particularly challenging. They are coded along with the primary anesthesia CPT code. For instance, qualifying circumstances code 99100 is defined by CPT® as, "Anesthesia for patient of extreme age, younger than 1 year or older than 70."

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