Moderate Sedation Calculator Comes to the Rescue
Although many factors affect procedural code selection in 2017, there is a calculator to make it easier.
Beginning Jan. 1, 2017, moderate sedation services are separately billed and paid using CPT® codes 99151-99153 and 99155-99157. To capture moderate sedation reimbursement appropriately, it’s important for you to calculate time and to report the new codes correctly. There is a calculator that can help, and here’s what you need to know to use it.
Provider, Time, and Age Are Factors
As shown in Table 1, moderate sedation is reported in 15-minute increments.
Table 1: Moderate sedation CPT® codes for 2017
|Service Provider Distinction||Code||Minutes and Age Distinction|
|Moderate sedation services provided by the same physician or other qualified healthcare 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;||99151||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)|
|Moderate sedation services provided by a physician or other qualified healthcare professional other than the physician or other qualified healthcare professional performing the diagnostic or therapeutic service that the sedation supports;||99155||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)|
When selecting code(s) to report moderate sedation, intraservice time is used to determine the appropriate code to report moderate sedation services. The intraservice time begins with the administration of the sedating agent(s) and ends when the procedure is completed, the patient is stable for recovery, and the physician or other qualified healthcare professional providing the sedation ends personal, continuous face-to-face time with the patient.
Table 2 provides examples to help you select the appropriate code(s) to report time spent providing moderate sedation services.
Table 2: Moderate sedation coding guidance
|Moderate sedation provided by physician or other qualified healthcare professional (same physician or qualified healthcare professional also performing the procedure moderate sedation is supporting)||Moderate sedation provided by different physician or other qualified healthcare professional (not the physician or qualified healthcare professional who is performing the procedure moderate sedation is supporting)|
|Total intraservice time for moderate sedation||Patient age||Code(s)||Code(s)|
|Less than 10 minutes||Any age||Not separately reported||Not separately reported|
|10–22 minutes||< 5 years||99151||99155|
|10–22 minutes||5 years or older||99152*||99156|
|23–37 minutes||< 5 years||99151 + 99153 × 1||99155 + 99157 × 1|
|23–37 minutes||5 years or older||99152* + 99153 × 1||99156 + 99157 × 1|
|38–52 minutes||< 5 years||99151 + 99153 × 2||99155 + 99157 × 2|
|38–52 minutes||5 years or older||99152* + 99153 × 2||99156 + 99157 × 2|
|53–67 minutes||<5 years||99151 + 99153 × 3||99155 + 99157 × 3|
|53–67 minutes||5 years or older||99152* + 99153 × 3||99156 + 99157 × 3|
|68–82 minutes||< 5 years||99151 + 99153 × 4||99155 + 99157 × 4|
|68–82 minutes||5 years or older||99152* + 99153 × 4||99156 + 99157 × 4|
|83 minutes or longer||< 5 years||Add 99153||Add 99157|
|83 minutes or longer||5 years or older||Add 99153||Add 99157|
Calculate the Services
As you can see from the explanation and tables provided, it can be overwhelming and time-consuming to code moderate sedation correctly. The professional coder teams at Lahey Health use a calculator tool made in Microsoft Excel (shown in Figure 1) to simplify matters. This intuitive and easy-to-use calculator is now available to all AAPC members at http://bit.ly/2rIP9hx.
To use the calculator, enter a Start Time and End Time, and answer two questions that relate to (1) whether moderate sedation and moderate sedation supports are both performed by the same provider, and (2) the age of the patient.
Jyoti A. Shah, MCom, CPC, COC, CRC, COSC, has 10 years of experience in medical billing and coding. She is a supervisor of the hospital-based diagnostic team in the Professional Coding and Education Department at Lahey Health, Burlington, Mass. She is passionate about mistake-proofing and efficiency improvement of coding process. Shah is a former professor of business management and marketing management for 20+ years at undergraduate and graduate levels in India. She is member of the Lahey Burlington, Mass., local chapter.
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