Basics of Moderate Conscious CPT codes
Moderate conscious sedation is a drug-induced depression of consciousness which is used for performing surgeries. With moderate conscious sedation the patient responds purposefully to verbal commands. Interventional radiology and open surgery procedures requires moderate conscious sedation. The old CPT codes for conscious sedation 99143, 99144, 99145 have been deleted. We have now CPT code 99151, 99152, 99153, 99155, 99156 and 99157 for coding moderate conscious sedation from 2017. Be careful now, since many of the CPT codes have been revised which will require to code sedation codes separately.
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Description of CPT code 99151, 99152, 99153, 99155, 99156 and 99157
The detail code description of CPT codes for moderate conscious sedation will help you to understand more about these procedure codes. Earlier we had only three CPT codes 99143, 99144, 99145 (deleted in 2017) which are used for coding sedation. But, now we are having six CPT codes for coding moderate conscious sedation procedures. Below is the details description of these CPT codes.
A physician or other qualified health care provider administers medication that allows a decreased level of consciousness but does not put the patient completely asleep inducing a state called moderate (conscious) sedation. This allows the patient to breathe without assistance and respond to commands. This type of sedation is used for less invasive procedures and/or as a second medication for pain.
These codes report sedation services provided by the same provider performing the primary procedure with the assistance of an independently trained health care professional to assist in monitoring the patient. CPT code 99151 is reported for the first 15 minutes of intraservice time for sedation services rendered to a patient younger than 5 years of age. CPT code 99152 is reported for the first 15 minutes of intraservice time for sedation services rendered to a patient age 5 years or older. CPT code 99153 is reported for each additional 15 minutes of intraservice time.
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)
CPT code 99155 is reported for the first 15 minutes of intraservice time for sedation services rendered to a patient younger than 5 years of age. CPT code 99156 is reported for the first 15 minutes of intraservice time for sedation services rendered to a patient age 5 years or older. CPT code 99157 is reported for each additional 15 minutes of intraservice time.
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)
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Moderate sedation codes 99151, 99152, 99153, 99155, 99156, 99157 are not used to report administration of medications for pain control, minimal sedation , deep sedation, or monitored anesthesia care (00100–01999). For coding correct procedure code, intraservice time of moderate sedation is used. For coding these codes, an independent trained observer who is qualified to monitor the patient during the procedure, should be present to monitor the level of consciousness.
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Changes with CPT code 99151, 99152, 99153, 99155, 99156 and 99157
Moderate sedation is no longer included in any procedures in the CPT manual. Moderate sedation may be separately reported when provided according to CPT guidelines.
Physicians and other qualified healthcare providers would report codes 99151, 99152, 99153 when performing both the procedure and the sedation. The physician or qualified healthcare provider would supervise an independent, trained observer in monitoring the patient during the procedure. The trained observer must not have other duties during the procedure.
Codes 99151 (under 5 years) and 99152 (5 years or older) are reported for the first 15 minutes of sedation provided by the same provider who is performing the procedure. Codes 99155 (under 5 years) and 99156 (5 years or older) are reported for the first 15 minutes of sedation provided by a provider other than the one performing the procedure.
These codes may be billed when at least 10 minutes of sedation have been provided.
Codes 99153 (same provider) and 99157 (other provider) are billed for each additional 15 minutes of sedation. At least 8 additional minutes of sedation beyond the first 15 must be performed before code 99153 or 99157 is billed.
The CPT manual has extensive guidelines and a time chart to assist with appropriate moderate sedation reporting.
Check with your payer for their guidelines regarding payment for moderate sedation. Physician practices should be aware that Medicare considers code 99153 a technical-only code and will only reimburse for 99151 or 99152 for moderate sedation services performed in the hospital by the same physician performing the procedure that the sedation supports.
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How to find out new and revised CPT codes
The new codes will have dark circle (⚫) in front of the CPT code which tells that it is a new CPT code . The revised codes will have a triangle Δ which will denote that the CPT codes is a revised code and the definition or description has been changed. So, be careful whenever you are using moderate conscious sedation , you have to use these CPT codes frequently as they are no more a part of many procedure codes.
References:
http://www.physicianspractice.com/coding/coding-moderate-sedation-different-2017
https://www.aapc.com/blog/36784-moderate-sedation-bundles-no-more/
https://www.acep.org/Physician-Resources/Practice-Resources/Administration/Financial-Issues-/-Reimbursement/Moderate-(Conscious)-Sedation-FAQ/
http://blog.supercoder.com/coding-updates/rule-change-if-youve-never-reported-moderate-sedation-before-read-this/
There is detailed decription about procedures, which is good thing, but should be more description about modifiers which can be billed with these procedures.
Thank you for Commenting Micheal…I have written articles on use of modifiers separately…I will shared more about modifiers used with these procedures soon..!!