Name of Manual - Blue Cross and Blue Shield of Minnesota

Moderate (Conscious)
Sedation
Monitored Anesthesia
Care
Patient Controlled
Analgesia
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (02/21/12)
Coding Policies and Guidelines (Anesthesia)
The physician who performs a procedure may bill moderate
sedation, codes 99143-99145, in addition to billing the procedure.
The use of these codes requires and includes an independent
trained observer. The observer is not eligible to bill for anesthesia.
Do not submit an anesthesia modifier with these codes.
When a second physician, other than the healthcare professional
performing the procedure, provides moderate sedation in the
facility setting (e.g., hospital, outpatient hospital/ambulatory
surgery center) the second physician reports 99148-99150. Codes
99148-99150 may not be reported in a non-facility setting (e.g.,
office).
Do not submit 99143-99150 with procedures that include
conscious sedation as an inherent part of providing the procedure.
These procedures are listed in Appendix G of the 2012 CPT
manual. The target symbol () will precede applicable codes in
the main body of the CPT manual.
Monitored anesthesia care (MAC) refers to instances in which an
anesthesiologist has been called on to provide specific anesthesia
services to a particular patient undergoing a planned procedure. In
this case, the physician performs a preanesthetic examination, is
physically present in the operating suite, monitors the patient’s
condition, makes medical judgments regarding the patient’s
anesthesia needs, and is prepared to furnish anesthesia service as
necessary.
For those circumstances under which such care is medically
necessary and requested by the performing surgeon, Blue Cross
will allow submission for MAC the same as for any other
anesthesia service.
Use modifier -QS for monitored anesthesia services.
Blue Cross recognizes that patient-controlled analgesia (PCA) has
demonstrated clear value to the patient. However, we do not
recognize a separate charge for this service because postoperative
pain control has already been included in the reimbursement of the
surgical fee, which was paid to the performing surgeon. Patient
controlled analgesia is also given to patients who have not had
surgery (such as cancer patients) for pain control. It will be
covered in such cases.
Standby Anesthesia standby occurs when an anesthesiologist or CRNA is
present in case his or her services are required for anesthesia, but
otherwise performs no medical intervention. Blue Cross does not
cover anesthesia standby. Standby services (99360) are considered
ineligible and should not be billed to Blue Cross or the patient.
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