Watch Your Usage of Sedation Codes In Medical Billing

In the new 2006 release, CPT introduced six new codes for moderate sedation (99143-99150, Moderate (conscious) sedation) and the six new codes replaced the two previously used conscious sedation codes (99141-99142). For the moment, the six new codes have been assigned by Medicare a status of “C”, which means that the codes are carrier priced.

In many instances carrier priced often means no reimbursement for the physician. Certain Medicaid programs will pay for moderate sedation for children. For example, if a child comes in with a high fever and the doctor suspects an illness like meningitis, the doctor may need to give the patient a spinal tap under moderate sedation – this would be a qualifying service.

The jury is still out on whether or not Medicare will remove the “C” status, but it is in most physicians best interest to use these codes now in their medical billing claims so the CMS can see that there is a line of utilization of this service. As the CMS gains more information on how frequently moderate conscious sedation is used, they are more likely to assign it national RVUs the next year.

If you have a busy practice it may be time to look at outsourcing your medical billing. Your medical billing partner can keep with the lightning fast changes of the coding industry. Not only are you likely to get the highest reimbursement on your medical billing claims, you will also receive them faster. Contact our offices to find out using our medical billing services can benefit your practice.

View all Articles by: Melissa Clark, CCS-P