Cardiology Coding Alert

Remember to count to 15 instead of 30.

Last month’s Cardiology Coding Alert broke the news about big changes to moderate sedation coding affecting many electrophysiology and vascular services. Now let’s take a closer look at what the new moderate sedation codes involve.

Observe Time and Age to Code Correctly

The CPT® 2017 moderate sedation code options look a lot like your 2016 options, 99143-99150. The main change you’ll want to watch in the descriptors relates to time.

Time: In 2016, the primary codes 99143, 99144, 99148, and 99149 all represented the first 30 minutes of intraservice time. CPT® 2016 add-on codes +99145 and +99150 covered each additional 15 minutes.

In 2017 all the codes represent 15 minutes of intraservice time.

Age: One area that stays the same is that in both 2016 and 2017 your coding differs depending on whether the patient is under 5 years old or is 5 years or older

Here are the codes you’ll use when the cardiologist provides the moderate sedation for a procedure she’s performing:

• 99151, 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 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).

New codes 99155, 99156, and +99157 are structured similarly to 99151-+99153 but apply to “services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports.”

Why Does This Change Matter?

In addition to getting new codes, CPT® 2017 also changes rules about reporting these codes. Previously, a moderate sedation symbol with a code meant that the procedure included moderate sedation, so you couldn’t report the moderate sedation in addition to the procedure code, says Marcella Bucknam, CPC, CPC-I, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, internal audit manager with PeaceHealth in Vancouver, Wash.

CPT® 2017 removes the symbols. That means you should report the new moderate sedation codes separately if your cardiologist sedates the patient. All of this is related to Medicare adjusting the Physician Fee Schedule. Medicare used to factor moderate sedation payment into the rates for procedure codes marked with the moderate sedation symbol. But in 2017, Medicare plans to remove moderate sedation payment from those procedures, reducing the payment you can expect to see for those codes.

Bottom line: If you want to be paid for moderate sedation services your cardiologist provides, you’ll need to report those services using the new moderate sedation codes in 2017.