Determining One MD or Two in Billing Procedures

In the following scenario, how would you code it? A child presents to the ED with a very high fever and enough symptoms that the physician on duty suspects meningitis. A spinal tap is performed under moderate sedation.

If the same doctor performed the sedation and the spinal tap, you would report it as 99143-99145 (moderate sedations services….performed by the same physician), however if two separate physicians performed the sedation, then you would need to identify the procedures as two separate procedures by two different physicians and use 99148-99150 (moderate sedation services …provided by a physician other than the health care professional performing the diagnostic or therapeutic service).

You will also need to show that one physician performed the spinal tap (62270, Spinal puncture, lumbar, diagnostic) and provides the moderate sedation. So, you should choose the age-appropriate code from 99143-99144. Also, don’t neglect to capture the first 30 minutes of intra-service time so there can be a maximum reimbursement on this claim. You would want to use codes 99143-99144 capture the first 30 minutes of intra-service time. For each additional 15 minutes, assign 99145.

By simply breaking down the procedures and separating out which physicians performed what function for the patient and always remembering to capture time when you can, you can get the most for your medical billing!

View all Articles by: Melissa Clark, CCS-P