Practice Management Alert

Question: The doctors in my office occasionally perform procedures in the office after putting the patient under moderate sedation. I-m never sure whether to report 99143-99145 or 99148-99150. Would you explain the difference?


Colorado Subscriber

Answer: You can easily determine the correct code set if you answer this question: Do the sedation and procedure involve one physician or two?

- One MD: When a physician performs the procedure and provides the sedation, you should use 99143-99145 (Moderate sedation services ... provided by the same physician performing the diagnostic or therapeutic service that the sedation supports -).

- Two MDs: When different physicians provide the procedure and sedation, use the second set of codes, 99148-99150 (Moderate sedation services ... provided by a physician other than the healthcare professional performing the diagnostic or therapeutic service that the sedation supports -).

Remember: Codes 99143-99144 and 99148-99149 capture the first 30 minutes of intra-service time. For each additional 15 minutes, assign 99145 or 99150.

Check with your carrier: You may be tempted to neglect reporting the sedation to the insurer because many carriers still don't reimburse for the moderate sedation. Leaving these codes off the claim could be a mistake, however, because some insurers have started paying for this service.