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Apply a Flat Fee for Sedation Codes

Apply a Flat Fee for Sedation Codes

A provider that is not an anesthesiologist, such as a pediatrician, should use the new moderate sedation codes (99143 – 99150) to capture the charge for the procedure’s base units. These codes eliminate any need to bill extra units. You should ignore billable units and use new time-based codes instead.

For example, a 4 year old presents for an MRI performed by a radiologist. A pediatrician provides moderate sedation throughout the procedure. The sedation lasts for thirty minutes. Before, you would have coded this sedation by with anesthesia code 01922. Because this procedure has seven base units and 2 time units, you would have billed 01922 x 9. On new 2006 claims, you should use the age specific moderate sedation code that represents the pediatrician’s assistant role, which is 99148. This code is for moderate sedation services other than those described in codes 00100-01999 that are provided by a physician other than the professional who is performing the service that the sedation supports, under five years of age, the first 30 minutes intra-service time. Because this sedation does not go to the thirty-first minute, you should not report the +99149 as well.

Physical status modifiers do not apply to the moderate sedation codes for non anesthesiologists. In the case above, if the patient had a severe systemic disease, you would have previously appended 01922 with P3, to indicate patient’s status. You would bill an additional unit of 01922 for a total of 8 units. You now should simply report 99148.

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