tci Part B Insider - 2007 Issue 24

RECIPE FOR REIMBURSEMENT: Look For Systemic Conditions That Support Moderate Sedation

Steer clear of bundled codes with 99143-99150So your Medicare carrier (or private payor) has decided to pay for moderate sedation codes 99143-99150 after all. Now how do you document and code them to make sure you get the correct payment? Our experts offer a few tips: - Look for MAC coverage policies. Often, the diagnosis codes that carriers list for Monitored Anesthesia Care (MAC) will also work for moderate sedation, notes Marvel Hammer, president of MJH Consulting in Denver, CO. The patient's condition and co-morbidities should be your main support for medical necessity, Hammer adds. Look for: heart and/or...

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