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We are having difficulty identifying the corresponding medical code for D9223. Patient has had to pay $600 out of pocket for the IV Sedation each of their last 3 visits. Their Health Insurance, Horizon Medicare Advantage of NJ (NJ Direct 15) has not been of much assistance. Can someone please help us out. We don't want the patient to have to pay again.
We use D9223 for the initial IV Sedation and D9223-76 for the added IV Sedation when required.
Thank you for any assitance you can provide.
JK
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Hi JK!
Below are some coding options for you for anesthesia for intraoral procedures:
00170 - Anesthesia for intraoral procedures, including biopsy; not otherwise specified
00172 - Anesthesia for intraoral procedures, including biopsy; repair of cleft palate
00174 - Anesthesia for intraoral procedures, including biopsy; excision of retropharyngeal tumor
00176 - Anesthesia for intraoral procedures, including biopsy; radical surgery
01999 - Unlisted anesthesia procedure(s)
And below are the moderate sedation coding options:
99151
Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age
99152
Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older
99153
Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; each additional 15 minutes intraservice time (list separately in addition to code for primary service)
99155
Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age
99156
Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient age 5 years or older
99157
Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes intraservice time (list separately in addition to code for primary service)
Hope this helps!
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We are being told that the 00170 codes are to be administered by an Anesthesiologist, not the Dr performing the Botox injections. The injections are administered in an office setting in the Dept of Oral and Maxilofacial Surgery in a hospital. The Dr is authorized to administer IV Sedation under the D9223 code.
What code can the Dr use to administer the IV Sedation in the office for the Botox treatment?
JK
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Hi JK!
Is it moderate sedation that is being administered?
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It is deep sedation. The patient can not take receiving the BOTOX injections without the IV Sedation.
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Hi JK!
I am not aware of a different CPT code to use for the deep sedation, but perhaps the insurer is looking for modifier 47, which stands for: regional or general anesthesia provided by the attending or assistant surgeon
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Thank you. We'll try that.
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