Wiki Conscious Sedation


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I am having trouble finding out exactly what documentation by the physician is needed for the new conscious sedation codes 99152 and 99153. Has anyone found anything in writing of what is required as far as documentation? Has anyone had any success in billing for these new codes with procedures since it has been unbundled since January 1st?

Thank you, Anna
MCS coding and billing

Our Compliance Department has a long list of Pre-Service requirements but most of which have already been documented by the providers even before these new codes came along. Overall they had to add review of personal and family history of sedation complications. The time 10-22 minutes we bill 99152, 23+ we bill 99152x2. 99153 is for facility use only. All the claims so far have been reimbursed.
The difficult thing for me is getting the providers to add that additional information to their pre-service assessment. I'm still working on that with some of them.
Hope this helps.
The narrative description of 99152 is the Initial 15 minutes. 99153 is an add-on code and should be used for each additional 15 minutes and portions over 8 minutes (i.e. 23 minutes). Medicare requires G0500 instead of 99152 for most GI endoscopies. Each additional 15 minutes will use 99153.

There is no facility reimbursement in Medicare's OPPS for either 99152 or 99153.

There were some errors in the January 2017 NCCI Edits that were corrected with the April NCCI Edits. You make sure that you download the new NCCI Edits now available at