tci ED Coding & Reimbursement Alert - 2005 Issue 6

READER QUESTIONS: Exclude Sedation Code From Fracture Claim

Question: When the ED physician performs a fracture reduction, is conscious sedation included or should I report it separately?Alabama Subscriber Answer: No, conscious sedation isn't technically included in the code for the fracture reduction. However, payers that follow Medicare rules don't reimburse for conscious sedation services in the emergency department. For private payers, you'll need to check with the individual carrier, because they may have varying policies on this issue.If you have sufficient documentation, you may potentially include the risk associated with the conscious sedation in your E/M service and capture high risk in the medical decision-making...

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