What is Moderate Sedation?
Moderate sedation, also known as conscious sedation, is a medical procedure where medication is used to relax a patient, but they remain awake and responsive. The patient can respond to verbal commands or light touch, and they do not need assistance with their airway or breathing. Heart function is generally stable during the procedure.
Reporting Moderate Sedation Codes
Codes for Physicians Performing Both the Procedure and Sedation
When a physician or healthcare provider performs both the procedure and the sedation, they report specific codes: 99151, 99152, and 99153. These codes are used when a trained observer monitors the patient during the procedure. The observer’s only job is to monitor the patient and not perform any other tasks.
Codes for Sedation Provided by a Different Provider
If the sedation is administered by one provider while another performs the procedure, codes 99155, 99156, and 99157 are used. These codes are based on the time spent administering sedation during the procedure. The time starts when sedation is given and ends when the procedure is over, and the patient is stable for recovery.
How to Bill for Moderate Sedation
Initial 15 Minutes of Sedation
For the first 15 minutes of sedation, providers use 99151 and 99152 if the same provider is performing both the procedure and sedation. If a different provider is giving the sedation, codes 99155 and 99156 are used. These codes are for patients who are under 5 years old (99151, 99155) or 5 years and older (99152, 99156).
Additional Sedation Time
If the sedation lasts longer than 15 minutes, 99153 (same provider) and 99157 (different provider) are used for each additional 15-minute block. At least 8 extra minutes of sedation must be given before these codes are billed.
Guidelines and Payment Considerations
The CPT manual provides a detailed guide and time chart to help with accurate reporting of moderate sedation. However, physicians should check with their payer for specific guidelines on payment, as different insurers may have varying rules.
For instance, Medicare only reimburses 99151 and 99152 for moderate sedation services in hospitals when performed by the same physician conducting the procedure. 99153 is considered a technical-only code and is not reimbursed by Medicare in these cases.
By following these guidelines, physicians can ensure proper documentation and billing for moderate sedation procedures.