concious sedation for 2017

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Who can help me figure out when a physician can bill for the sedation with the new codes? If a nurse is administering it under the physician direction? OR does the physician have to actually administer it? When an anesthisologist is doing it then the physician cannot bill? A lot of confusion with this. no one seems to know exactly how this is going to work. Appreciate it.

Thanks,
 

Margaret Morgan

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Theresa,

This is very confusing, there are two types of moderate (conscious) sedation codes, physician directing the sedation AND who is performing the procedure at the same time. The other is provider providing the sedation is NOT performing the procedure. I take the 2nd kind as CRNA directed sedation.

First type:
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 , patient age 5 years or older
Sedation must at least 10 minutes of sedation to bill this code
Sedation less than 10 minutes is not billed.

+99153 Each additional 15 minutes of intraservice time
Each additional must have additional 8 minutes to bill this code
(Use 99153 in conjunction with 99151, 99152)
(Do not report 99153 in conjunction with 99155, 99156)

second type:
99155 Moderate sedation services provided by a physician or other qualified health care professional performing the diagnostic or therapeutic service other than the physician or other qualified health care professional 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

99156 initial 15 minutes of intraservice , patient age 5 years or older
Sedation must at least 10 minutes of sedation to bill this code
Sedation less than 10 minutes is not billed.

+99157 Each additional 15 minutes of intraservice time
Each additional must have additional 8 minutes to bill this code
(Use 99157 in conjunction with 99155, 99156)
(Do not report 99157 in conjunction with 99151, 99152)


For codes 99151, 99152, 99153 when MD /QHCP performs the procedure and provides the sedation services, they will supervise and direct an independent trained observer who will assist in monitoring the patient’s level of consciousness and physiological status throughout the procedure

An independent trained observer is an individual who is qualified to monitor the patient during the procedure, who has no other duties (e.g., assisting at surgery) during the procedure

the chart In the CPT book helps understand the time requirements.

I hope this helps,

Margaret Morgan, CPC, CIRCC​
 

sherring1

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Moderate Sedation

Just for clarification, this is my physician's question:

"A physician scrubbed on a procedure (PM. ICD, Cath, PCI, without anesthesia assistance) who orders/directs administration of conscious sedation, but who is not directly managing airway or pushing meds, is he/she still able to bill for the conscious sedation? As opposed to something like a TEE where the operator is managing the airway in addition to the procedure..."

He just wants to clarification to make sure he is billing correctly.

Thanks!
 

cgaston

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Just ordering it would not warrant use of these codes since they are to be used by the physician administering the anesthesia.
 
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Just ordering it would not warrant use of these codes since they are to be used by the physician administering the anesthesia.

cgaston,
I am thinking the same thing that ordering or even directing the nurse to administer it is not what these codes are to be used for. But I cannot find anything other then the description of the codes to make me for sure on it. Does anyone else know how these codes should be used?
 

cgaston

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If the Anesthesiologist is administering sedation then the Anesthesiologist would bill for his/her services. That part hasn't changed. The only thing that has changed is if the provider performing the surgery also administers the sedation.

Here is the description from the 2017 Procedural Reference Guide for Coders:

99151-99153 "The provider performing a diagnostic or therapeutic procedure administers one or more drugs to reduce the patient's level of consciousness in the presence of an independent trained observer. He asks the patient to react purposefully to verbal commands. The provider administers further doses of the drugs as required. He monitors the patient until the end of the procedure. He ensures the patient's condition is stable at that time"

99155-99157 "The provider other than the one performing a diagnostic or therapeutic procedure administers one or more drugs to reduce the patient's level of consciousness in the presence of a an independent trained observer. He asks the patient to react purposefully to verbal commands. The provider administers further doses of the drugs as required. He monitors the patient until the end of the procedure. He ensures the patient's condition is stable at that time"

These codes only come in to play if your Surgeon (or someone in your group for the 2nd set of codes) administers the sedation used for the surgery. So you just need to check the report and see if an Anesthesiologist was on the case. If so, these codes would not apply to your provider.

ETA: I hope this helps!
 
Last edited:
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626
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Seymour, TN
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If the Anesthesiologist is administering sedation then the Anesthesiologist would bill for his/her services. That part hasn't changed. The only thing that has changed is if the provider performing the surgery also administers the sedation.

Here is the description from the 2017 Procedural Reference Guide for Coders:

99151-99153 "The provider performing a diagnostic or therapeutic procedure administers one or more drugs to reduce the patient's level of consciousness in the presence of an independent trained observer. He asks the patient to react purposefully to verbal commands. The provider administers further doses of the drugs as required. He monitors the patient until the end of the procedure. He ensures the patient's condition is stable at that time"

99155-99157 "The provider other than the one performing a diagnostic or therapeutic procedure administers one or more drugs to reduce the patient's level of consciousness in the presence of a an independent trained observer. He asks the patient to react purposefully to verbal commands. The provider administers further doses of the drugs as required. He monitors the patient until the end of the procedure. He ensures the patient's condition is stable at that time"

These codes only come in to play if your Surgeon (or someone in your group for the 2nd set of codes) administers the sedation used for the surgery. So you just need to check the report and see if an Anesthesiologist was on the case. If so, these codes would not apply to your provider.

ETA: I hope this helps!

It seems like there are two opinions. I am thinking you are right and by the description you have given out of the reference guide sounds like the physician has to actually administer it and not just direct someone else to do it.

Can you tell me which procedural reference guide you found this information? Thanks!
 
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That is my question also. I have a physician asking me about it, but he says they only instruct someone to administer the sedation. It's even in their report to "See Nurses notes for sedation medication and dosage". Everything I am reading is that the physician has to be the one to "push" the medication to be able to use this code. Is that what everyone else is finding?
 

cgaston

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It seems like there are two opinions. I am thinking you are right and by the description you have given out of the reference guide sounds like the physician has to actually administer it and not just direct someone else to do it.

Can you tell me which procedural reference guide you found this information? Thanks!

Sure! It's The Coding Institute's 2017 Procedural Reference Guide for Coders

 

KTOWNSEL

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99152 & 99153

I understand the timing "rules" of billing these two codes, but should a modifier 26 be used with either
of these? I am seeing Medicare PC/TC indicator on my Encoder Pro website. Curious as to if this does apply.
Anyone?
 

tmedina99

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Nuse documentation on Moderate sedation

Who can help me figure out when a physician can bill for the sedation with the new codes? If a nurse is administering it under the physician direction? OR does the physician have to actually administer it? When an anesthesiologist is doing it then the physician cannot bill? A lot of confusion with this. no one seems to know exactly how this is going to work. Appreciate it.

Thanks,

HI- In the Op report, the physician mentions that the procedure was performed under moderate conscious sedation. The nurse documents on a separate report (cath lab chron log) all criteria to meet coding for moderate conscious sedation. Does anyone know if this documentation is enough to bill 99151-99153?? What if the Op doesn't mention type of sedation/anesthesia, but moderate conscious sedation is performed, is the Nursing documentation enough to bill 99151-99153?
 

mdm58

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99152 99153

In CPT it states Moderate sedation by the same provider 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 pts level of consciousness . In our Cath lab there is a nurse listed as the monitor. And per the ACC our Drs can bill the 99152 and 99153 but we are having an issue because the 99153 has a status indicator that this code can only be billed by the facility.

I do not feel this is correct as 99153 is an add on code I have ordered an on demand webinar to see if I can get clarification.
I am thinking the problem with these codes are just like the problem we had initially with the 93653 and the add on code 93621 as 93621 is an add on to 93620. All payers were denying these because of no primary code on the claim but 93620 is actually included in the 93653. I think it took from Jan to April to get that problem corrected.
I think this may be the issue..


We will see..
 
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