tci Medicare Compliance & Reimbursement - 2024 Issue Q3

Reader Questions: Stay Away From This Conscious Sedation Scenario

Question: Our internal medicine doctors want the anesthesiologists to set up a system for routine anesthesia sedation of difficult to sedate patients. Do Medicare, Medicaid, and commercial insurances pay for this? What type of documentation do we need to do to prove medical necessity and to get paid? Colorado Subscriber Answer: Anesthesiologists do not usually bill for conscious sedation. Sedation is provided by either the physician performing the service, or a qualified health care professional (QHCP). Moderate sedation codes, ranging from 99151-99153 (Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic...

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