The removal of moderate (or conscious) sedation from hundreds of CPT codes and the creation of six new codes to be used for billing the service means providers who perform moderate sedation, even those who also are performing primary services, have more options for being reimbursed for their work. The changes were effective beginning January 1, 2017.
Medicare offered its stamp of approval for unbundling the sedation and primary services in the 2017 Medicare Physician Fee Schedule, saying, “This coding change [provides] for payment for moderate sedation services only in cases where it is furnished.”
According to the Physicians Practice article, “Coding for Moderate Sedation is Different in 2017,” the six new codes for billing moderate sedation allow providers to indicate who performs the sedation, how long the sedation service lasted, and the age of the patient.
|Code||Provider Performing Sedation and Primary Service||Code||Provider Performing Sedation but not Primary Service|
|99151||“initial 15 minutes of intraservice time, patient younger than 5 years of age”||99155||“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”||99156||“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)”||99157||“each additional 15 minutes intraservice time (list separately in addition to code for primary service)”|
Another change in the moderate sedation coding guidelines is the length of the intraservice time required to bill for the service. According to CIPROMS Coding Liaison Cara Geary, previously the threshold for coding moderate sedation was 16 minutes. With the new codes, physicians can bill sedation if they spend 10 or more minutes in intraservice time. Additionally, at least seven minutes must pass to report an additional unit.
For example, a physician who spends 21 minutes sedating a 4-year-old patient could bill only 99151 for minutes 1-15. Minutes 16-21 would not be billable because they didn’t add up to at least seven minutes. However, if that same physician spent 27 minutes sedating a 4-year-old patient, she could bill 99151 for minutes 1-15 and 99153 for minutes 16-27 since she spent at least seven minutes after the initial intraservice range.
“This is closer to what [ER physicians] are doing with simple joint dislocation reductions,” Geary said. “Prior to these new codes, there were a lot of instances where we could not bill sedation, but had to take all the risks for it. Now those are billable services.”
According to Geary, there are also a few codes for services occasionally done in the ED that used to have sedation bundled, but are now separately billable, including chest tube placement and elective cardioversion.
For more information, review the CPT coding guidelines for codes 99151-99157.
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