Procedural Sedation Billing Guide

(Aug  2010 Revision)

Coding for Procedural Sedation

  1. Two doctors must be involved to be eligible to code for sedation.
    1.  Doctor 1 -  bills for the procedure
    2.  Doctor 2  - bills for the sedation
  2. Look up the procedural code (on cheat sheets, www.emlondon.ca, or SOB)
  3. Doctor 1 -  codes  with procedure code using the suffix 'A' (i.e. F032A)
  4. Doctor 2 - codes with the following:
    1. if the Procedure has a (6) listed behind it - use the same code but with suffix 'C'
    2. if no (6) or no procedure code listed, use E003C
    3. For BOTH scenarios document how many time units* you were in attendance
    4. Document and code any after hours anesthesia premiums**
    5. Document and code any Special Units*** -  NOTE: n/a if E003C is used

IF you provide sedation services for a CONSULTING SERVICE (ie Ortho) please document the CONSULTANT's name on the chart beside your billing codes

Basic Time Units

  • 1 unit = 15 minutes = $14.54
  • Start time = begins when in 1st attendance with the patient with the purpose of initiating sedation
  • Stop time = time when physician is no longer needed and patient is safe to leave with RN

Time Premiums

  • Monday - Friday 17:00-24:00 hrs    E400C (increase Anes fee by 50%)
  • Sat/Sun/Holiday 07:00 - 24:00 hrs    E400C (increase Anes fee by 50%)
  • Nights 24:00 - 07:00 hrs    E401C (increase Anes fee by 75%)

Special Units (NOT eligible if used with E003C)

  • ASA III    E022C (+4 units)
  • ASA IV    E017C (+10 units)
  • BMI > 45    (BMI = wt(kg)/ht(m)2)    E010C (+ 2 units)

Example

37 y.o patient assessed for fall Saturday afternoon, requires reduction of ankle and 18 minutes of sedation for procedure

Doc # 1 - H153 + F075A + (typical ER charting)
Doc # 2 - F075C +  2 time units + E400C (documents anesthesia assessment and times on blue sheet)

** NO MORE SEDATION SHEETS - EVERYTHING IS CODED ON BLUE COPY OF CHART**