Health Information Management

Conscious sedation now covered under anesthesia

APCs Insider, February 4, 2005

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Conscious sedation now covered under anesthesia

Question: Our facility heard about a new CMS transmittal that says conscious sedation is now covered under anesthesia. Could you tell us about this change?

Answer: Effective February 22, 2005, Medicare has made a policy change regarding the use of modifiers -52, -73, and -74.  This policy change effects facility coding only.

Transmittal 442 "Hospital Outpatient Prospective Payment System: Use of Modifiers -52, -73, and -74 for Reduced or Discontinued Services" can be accessed at http://www.cms.hhs.gov/manuals/pm_trans/R442CP.pdf.

According to the transmittal, for purposes of billing hospital outpatient services the definition of anesthesia has expanded to include local, regional block(s), moderate sedation/analgesia ("conscious sedation"), deep sedation/analgesia, and general anesthesia. Prior to this change, CMS did not consider conscious sedation to be part of anesthesia, but now it does.  Here is a summary of the updates:

 Modifier -73 ("Discontinued procedure prior to administration of anesthesia") now includes the use of conscious sedation. The patient must be in the room where the procedure is being performed. Procedures discontinued while the patient is in a pre-procedural holding area do not count.

 Modifier -74 ("Discontinued procedure after administration of anesthesia") now includes the use of conscious sedation. The patient must in the room where the procedure is being performed. Procedures discontinued while the patient is in a pre-procedural holding area do not count.

 CMS stated modifier -52 ("Reduced services") should be used to report partial reduction or discontinuation of radiological procedures, or other procedures that do not include anesthesia, including conscious sedation. Modifiers -73 and -74 are not used to indicate discontinued radiological procedures.

Note: CMS at this time has not released guidance stating which modifier is used when radiological procedures requiring anesthesia are discontinued. Watch for further updates.



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