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Report anesthesia charge using revenue code 370 and no HCPCS

APCs Weekly Monitor, April 20, 2007

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QUESTION: In the moderate sedation codes section of the CPT Manual (99143-99150), the preface states that the code includes the "administration of the agent(s)." So, it appears that one cannot separately code and bill for the administration of the IV sedation involved in moderate sedation. Do you know if this guidance is true only on the physician side of coding (for whom the CPT Manual is written), or is it also true for hospital/facility billing?

I ask this since, in a somewhat analogous situation, the preface for the critical care codes mentions that the bundled codes apply only to physician billing. On the hospital side, the procedures are not bundled.

The CCI edits don't edit out the infusion or injection codes from the moderate sedation codes, but this is not always the most inclusive indication of appropriate billing.

ANSWER: Sedation is a form of anesthesia in the hospital. With the addition in 2005 of Appendix G to the CPT Manual, and the changes to sedation codes in 2006, it remains extremely difficult for hospitals to use CPT codes to report sedation. CMS wants providers to report the charge data, since anesthesia is packaged for hospitals.

Whenever providers perform sedation in the hospital, a good option is to report an anesthesia charge under revenue code 370 with no HCPCS code. This correctly reports the expense of the nurse monitor and other sedation resources, but does not lead to any edit problems with claims.

Here is an example: If a nurse administers an IV push (90774/90775) or an IV infusion (90765/90766) to a patient under moderate sedation, bill the moderate sedation using revenue code 370. Do not separately bill the administration of the sedating agent (i.e., the code for the IV push or the IV infusion). These codes are included in the moderate sedation charge, which you bill using a 370 revenue code.

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