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  1. It has been four months since I had concious sedation for a colonoscopy. My GI doc gave me the IV med. I have been on the phone many times with my insurance company trying to get them to pay for it. I finally have got them to agree to cover it. (They normally only cover conscious sedation done by anesthesiologist THEY SAY) They tell me in the future I must make sure that it is done by anesthsiologist. That is bull, I spent some time in our GI lab and I never saw a anesthsiologist in there once. The GI lab docs always gave it. When I had my endoscopy done the conscious sedation was administered by my GI doc and I had no billing problems. I did have conscious sedation done by anesthesiologist for my cysto/retro pylo but that was done in OR. What are some of your thoughts on this.
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  2. 13 Comments

  3. by   Brownms46
    I did a contract in a GI specialty clinic, where they did Sigs, Colonoscopys, EGDs, etc..etc. And the nurses push the drugs...not the MD. And from talking to others in the same area...this is how it is done in most GI procedures.

    The only time I saw an anesthesiologist/ nurse-anesthetist present during conscious sedation...was when I did a contract in an Eye surgery clince that did Cataracts, and other minor eye outpt. surgical procedures. But this was back in the late 90's..in S. C.

    Conscious Sedation is done for many procedures including dental....and also no anesthsiologists present. But I guess this would depend also on the state that it is done in....as we all know...each state is different.

    During conscious sedation, you're sedated , you can follow commands, but you can maintain your own airway and you retain protective reflexes. You're monitored closely with and then recovered. Most of the time..rarely a problem.
  4. by   pebbles
    My only thought was that insurance companies are money-grubbing stupid-heads.

    This is my intelligent, articulate thought for the day.
    Please continue.
  5. by   Brownms46
    Ditto...:chuckle
  6. by   LasVegasRN
    There are certain procedures that allow for an anethesiologist. There are tables that are used (most insurance companies use the Medicare tables) to simply look up a number (called a CPT code) and see if it's allowed or not. The same with an assistant surgeon.

    What's missing is the patient has no knowledge of this and it is not their fault. We don't carry around Medicare allowables to determine what's covered or not, and we should not have to.
  7. by   pebbles
    Conscious sedation is done by nurses who are specially certified in this area here.... it is considered a "transfer of function" role that nurses can do IF they are specially trained... ditto goes for epidurals. I don't see why it matters who gave the darn drug - you still needed it.
  8. by   oramar
    Las Vegas baby, I like that new picture! Here is what I think, or at least what I suspect. Refusing to cover conscious sedation is the new trick from the old bag of trick. If even 1/4 of the patients pay out of their own pockets it is a windfall. However, if someone makes a fuss it gets covered.
  9. by   fedupnurse
    It used to be, not sure if it still is, that if you receive Diprivan you had to have an anesthesiologist on board as well. If the Insurance Co. had a half a brain they'd know having this doc would jack up their costs. It does make you wonder if they aren't in cahoots sometimes doesn't it?
  10. by   Zee_RN
    Originally posted by pebbles
    My only thought was that insurance companies are money-grubbing stupid-heads.
    LOL. That's the obvious answer.
  11. by   ptnurse
    You know how to deal with an insurance company. If you can't get a reasonable answer out of the first stupid head you talk to, just hang up and call back. You will never get the same answer twice. Eventually you find someone who is reasonable.(Usually)
  12. by   NRSKarenRN
    You know how to deal with an insurance company. If you can't get a reasonable answer out of the first stupid head you talk to, just hang up and call back.
    That's S.O.P. (standard office procedure) in my intake office re insurance verification!
  13. by   sharann
    I don't understand.
    Is GI doc billing seperately for "anesthesia" services?
    I believe that he may be. The nurses are the ones who recover and monitor you (and give the CS usually), so maybe the nurses should bill (right, like that would occur). The doc did the scoping and should only bill for his services.
  14. by   boggle
    I have found that the doc's office can sometimes rebill the insurance using a different billing code. Often works. Makes me wonder did they bill under the wrong code in the first place.

    Your story reminds me of my old insurance plan. It would pay for pathology to examine the pap smear slide, but not for the doc's exam to obtain the pap smear. I kept waiting for then to issue a do- it - yourself pap smear home kit!!

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