Some specific points that you should be aware of:
�� CPT coding guidelines for conscious sedation codes instruct practices not to report Codes
99143 to 99145 in conjunction with the codes listed in CPT Appendix G. NHIC will follow
the National Correct Coding Initiative, which added edits in April 2006 that bundled CPT
codes 99143 and 99144 into the procedures listed in Appendix G (There are no edits for
code 99145; it is an add-on-code and it is not paid if the primary code is not paid.)
�� In the unusual event that a second physician (other than the one performing the
diagnostic or therapeutic services) provides moderate sedation in the facility setting for
the procedures listed in CPT Appendix G, the second physician can bill 99148 to 99150,
but cannot report these codes when the second physician performs these services (on the
same day as a medical/surgical service) in the non-facility setting.
�� If an anesthesiologist or CRNA provides anesthesia for diagnostic or therapeutic nerve
blocks or injections, and a different provider performs the block or injection, then the
anesthesiologist or CRNA may report the anesthesia service using CPT code 01991. In
this case, the service must meet the criteria for monitored anesthesia care. If the
anesthesiologist or CRNA provides both the anesthesia service and the block or injection,
then the anesthesiologist or CRNA may report the anesthesia service using the conscious
sedation code and the injection or block. However, the anesthesia service must meet the
requirements for conscious sedation and if a lower level complexity anesthesia service is
provided, then the conscious sedation code should not be reported.
�� There is no CPT code for the performance of local anesthesia, and as such, payment for
this service is considered to be part of the payment for the underlying medical or surgical
service. Therefore, if the physician performing the medical or surgical procedure also
provides a level of anesthesia lower in intensity than moderate or conscious
sedation (such as a local or topical anesthesia), then the conscious sedation code
should not be reported and the contactor will allow no payment.
When denying claims, as appropriate under this policy, contractors will use the message when
the service is bundled into the other service: “Payment is included in another service received on
the same day.”
Contractors will adjust claims brought to their attention that were not processed in accordance
with the Medicare physician fee schedule data base indicators assigned to the conscious sedation
codes. Requests for reopening may be submitted to the Written Inquiries Department in your
jurisdiction.
