Payment for procedural sedation

As surgical procedures become less invasive and medical procedures become more invasive, the role of procedural sedation has become more important. The resulting proliferation of settings for procedural sedation and providers rendering sedation has brought attention to the economics of this service from nonanesthesia specialists and payers. Rapidly escalating expenditures for sedation have led to scrutiny from public and private insurance carriers. The review will summarize these trends and predict changes in coding and payment for procedural sedation.

Changes in coding for sedation by proceduralists have raised questions about the value of procedural sedation that have implications for anesthesiologists and other specialists administering sedatives for their own or others' procedures. The emerging literature on the role of registered nurses in administering new sedative agents has led to a re-examination of the role of anesthesiologists and other physicians in providing this care. Workforce projections demonstrating an ongoing shortage of anesthesia and nursing personnel have created a dilemma about the availability of professionals to meet the growing need for sedation. A proliferation of Medicare medical necessity rules may limit the availability of payment for monitored anesthesia care in many settings.

Coding, payment rules and fees for procedural sedation are likely to change in the coming 2-5 years. Those responsible for providing such services must consider the economic, clinical and workforce issues underlying these changes when planning to undertake or expand a commitment to sedation.