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Topics in Practice Management |

Moderate Sedation for Chest Physicians*

Norman A. Cohen, MD; Stanley W. Stead, MD, MBA
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*From the Department of Anesthesiology and Peri-Operative Medicine (Dr. Cohen), Oregon Health and Science University, Portland, OR; Department of Anesthesiology and Pain Medicine (Dr. Stead), University of California, Davis, CA.

Correspondence to: Norman A. Cohen, MD, Department of Anesthesiology and Peri-Operative Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, UHS-2, Portland, OR 97239-3098.



Chest. 2008;133(6):1489-1494. doi:10.1378/chest.07-2150
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Specialists in pulmonary and critical care medicine frequently perform invasive procedures that may require sedation or anesthesia for patient comfort. The number and complexities of interventional pulmonary procedures that can be performed in the bronchoscopy suite or critical care unit continues to expand. Procedures that formerly were done only in the operating room on inpatients are now done routinely in the office, ambulatory surgery center, or hospital outpatient department. No matter the setting, the key to successfully performing these procedures is a safe, pain-free environment for the patient. Anesthesia care and procedural sedation services share the goals of providing the patient comfort during a painful procedure and the operating physician an acceptable working environment. Historically, anesthesiologists have applied the expertise gained in managing anesthesia for major surgeries to sedation care for minor procedures. While the supply of anesthesiologists and anesthetists has shown only a modest increase, the growth in minimally invasive procedures has been explosive in recent years. To meet demand, a service, originally known as conscious sedation and now referred to as moderate sedation, has become common, in which the operating physician supervises a specially trained sedation nurse. This article will provide a clinical definition of moderate sedation and then focus on ways to properly code and bill for pulmonary procedures performed with moderate sedation.


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