Moderate Sedation Coding Update

Moderate Sedation Coding Update

For 2017, the AMA revised the codes and coding rules for moderate (conscious) sedation. In prior years, moderate sedation was bundled to (e.g., not separately reported or paid) with nearly 450 CPT® codes. Now, moderate sedation always is reported and paid separately, when medically necessary and properly documented. The CPT® codebook replaced the previous moderate sedation codes with six new codes.

When a different provider performs the primary procedure and the moderate sedation, the appropriate codes are:

99155 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; 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)

In these cases, the provider performing the moderate sedation (not the provider performing the primary procedure) will bill for the moderate sedation. No independent observer is necessary to monitor the patient.

When the same provider performs the primary procedure and the moderate sedation, the appropriate codes are:

99151 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; 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)

Although the provider performing the primary procedure will report the moderate sedation, there must be a trained observer to assist.

John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

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John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

4 Responses to “Moderate Sedation Coding Update”

  1. Linda Hillman says:

    Love the information

  2. H Yerden says:

    This is good information but I question Physician billing for cpt 99153.
    We have received denials for that code as it is considered a Technical code only and should only be billed by the Facility.
    Please clarify, our appeals have been denied, so is this a Technical code only and there has been conflicting information on this subject.

  3. PARTHASARATHI PANDURANGAN says:

    The moderate sedation is administered by anesthesiologist but the sedation is maintained and observed throughout the procedure by a provider who is doing the original procedure .
    Can we bill moderate sedation CPT codes for the provider, Like CPT 99153, 99152 & 99153.

  4. Laya says:

    99153 is the additional 15 mins of intraservice. In this case, As per CMS final rule states that for 99153 it is a practice expense only code; therefore, if the moderate sedation takes more than 15 minutes, and the service is done in a facility setting then it would be considered a Part A service. Part B would pay for the initial 15 minutes, but anything over 15 minutes would be billable to Part A.

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