Moderate Conscious Sedation coding 99151-99157

Moderate conscious sedation (MCS) is a drug given for performing major procedures. The MCS helps in inducing depression of consciousness. MCS includes administration of agents, maintenance of sedation, monitoring of oxygen saturation, heart rate, blood pressure and establishment of IV access. There are few common CPT codes used for coding MCS in Interventional and surgical procedures.  Let us checkout how to code these CPT codes in medical coding.

CPT codes used for Moderate Conscious Sedation

We have new CPT codes for Moderate Conscious Sedation from 2017. The below CPT code 99143, 99144 and 99145 are deleted from CPT codebook in 2017. There are three CPT codes used frequently which we discuss in the section. The first code 99143 is used for minors or babies who are younger than 5 years of age. The second code 99144 is used for patients older than 5 years of age. The last code 99145 is an add-on code and can be used with any of these 99143 and 99144 CPT codes. Below is the detail description of these CPT codes

99143– Moderate Sedation provided by the same physician performing the diagnostic or therapeutic service that the sedation supports for patients younger than 5 years of age for the first 30 minutes of intraservice time.

99144– Moderate Sedation provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, for patients 5 years of age or older for the first 30 minutes of intraservice time.

99145– for each additional 15 minutes of intraservice time.

The above three CPT codes are replaced with new CPT codes 99151-99157. Below is the coding description.

99151 Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age

99152    initial 15 minutes of intraservice time, patient age 5 years or older

+ 99153 each additional 15 minutes intraservice time (List separately in addition to code for primary service)

99155  Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age

99156  initial 15 minutes of intraservice time, patient age 5 years or older

+ 99157 each additional 15 minutes intraservice time (List separately in addition to code for primary service)

Moderate sedation is no more included with cpt codes for central or peripheral venous catheter placement, AV fistula procedure, extremity vascular catheterization codes, stent or angioplasty procedure and few drainage abscess cpt codes. So, do code the moderate sedation codes 99151-99157 separately while coding any major surgery procedure codes.

Time- Major Factor to decide Moderate Conscious Sedation CPT Code

As we see these CPT codes, time is considered as the deciding factor. CPT Code 99151, 99152, 99155, 99156 are reported for the first 15 minutes of intraservice time providing moderate sedation. CPT Code 99153, 99157 are reported for each additional 15 minutes, in addition to the code for the primary service.. So, always check the total time for which MCS is given to assign correct CPT code. The first 30 minutes CPT code can still be coded if the time has passed the halfway i.e. minimum 16 minutes or more. So, even the MCS is given for 16 or more minutes we can go ahead and code 99151 or 99152 depending on the age of the patient. So, never think the time should be exact 30 minutes or more to code these CPT codes. Same thing goes with add-on code 99153 & 99157, which can be coded even if the time is 8 minutes or more. So, next time check the MCS time properly to calculate and assign correct codes. For example, suppose we have to code 55 minutes for MCS  for  25 year old patient in the presence of  independent trained observer, then the cpt codes will be 99152 (intial 15 minutes), 99153 x 3 (15 to 55 minutes). So, the add-on code can be used as many times to equal the time.

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