If you bill for moderate sedation, things just got a little easier for you next year. CPT® 2017 has changed how you code these services for more than 400 procedures.
You’ll notice there’s something missing in your 2017 CPT manual. All those bulls-eyes that indicated a code could include moderate sedation are gone. And the old moderate sedation codes (99143-99150) have been replaced with a new batch (99151-99157).
This means that to accurately code for moderate sedation with a procedure, you’ll report the procedure code as well as one of the new moderate sedation codes. The other big news is that you won’t have to use modifier 52 (Reduced services) any longer if you perform the procedure without moderate sedation.
There is one more thing, you’ll no longer have to keep track of which CPT codes include the service and which ones don’t — because in 2017 none of the codes include moderate sedation any more.
So what does moderate sedation coding look like in 2017? For the new codes, you’ll make your selection based on three criteria:
- Who performs the service — the operating physician or a separate qualified healthcare practitioner
- The patient’s age — CPT draws the line at younger than 5 years of age and 5 years and older
- The length of “intraservice” time — the codes are in 15-minute increments.
For coding purposes, CPT defines “intraservice” time as follows:
- Begins when you administer the sedating agent(s);
- Ends when you’ve completed the procedure, the patient is stable for recovery status, and the sedating provider ends personal continuous face-to-face time with the patient;
- Includes ordering and/or administering the initial and subsequent doses of sedating agents;
- Requires the provider to be in continuous face-to-face attendance with the patient;
- Requires monitoring the patient’s response to the sedating agents, including:
- Periodic assessment of the patient;
- Further administration of agent(s) as needed to maintain sedation; and
- Monitoring the patient’s oxygen saturation, heart rate and blood pressure.
Let’s look at an example to see how you might apply these codes:
A 52-year-old male patient undergoes a colonoscopy that requires moderate sedation. The physician performs both the procedure and the moderate sedation while supervising and directing an independent trained observer, who assists with monitoring the patient’s level of consciousness and physiologic status during the procedure. Both the physician and observer continuously assess the patient throughout the procedure, and the physician orders and provides additional doses of sedating agent as needed. During the scope, the physician uses hot biopsy forceps to remove two polyps. The procedure lasts 20 minutes, and the intraservice time runs 27 minutes.
In this case, you would report the following:
- 45384 — Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesions by hot biopsy forceps
- 99152 — 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 age 5 years or older
- +99153 — … each additional 15 minutes intraservice time (List separately in addition to code for primary service)
Note: If the moderate sedation intraservice time is less than 10 minutes, CPT states that you cannot separately report it.
- In 2017, you separately report moderate sedation with new codes because the service is no longer included in any other CPT code.
- The new moderate sedation codes break down by 15-minute increments of intraservice time, the patient’s age, and whether the operating physician or another provider performs the service.
- You cannot separately report moderate sedation lasting less than 10 minutes.
For more information on the new moderate sedation coding rules for 2017, Coding Leader offers the webinar Moderate Sedation 2017 CPT Update on Dec. 1 at 1 p.m. ET.