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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10 Responses to “Moderate Sedation Calculator Comes to the Rescue”

Peggy Price says:

July 7, 2017 at 5:07 am

This moderate sedation calculator comes up with an incorrect Bit address so we can’t access it.

Terry Fletcher CPC CCC CEMC says:

July 12, 2017 at 11:57 am

We can’t access the information

Terry Fletcher CPC CCC CEMC says:

July 12, 2017 at 12:05 pm

Actually once you sign in you can access it from that link. Great tool. Thank you

Natalia says:

July 13, 2017 at 12:29 am

I have gotten a couple denials recently saying thay the moderate sedation codes fall under consolidated billing if a patient is in a SNF. Is that correct?