Wiki help witht he new 2017 moderate sedation codes

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Margaret Morgan

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Good morning,

I have a question regarding the new moderate (conscious) sedation codes; which has always been bundled with the catheterization and other procedure codes. I have been educating myself to be ready in January. I think I have the basics down, however I have question about coding sedation when 2 procedures by two different physicians is performed during the same session.

an example is 65 year old patient has crushing chest pain and diagnostic catheterization is performed by doctor A. critical blockage is found but Doctor A is diagnostic cardiologist and doesn't have the training to perform the intervention to place a coronary stent to open up the blockage. Doctor B, an interventional cardiologist is called in and takes over the case. Doctor A leaves and Doctor B places a stent to open blockage. Too make this easier for me to understand, let’s say each procedure took 15 minutes.

My question, how do I bill the sedation? Is it billed under Dr. A? Or is it split between the two providers? Do I bill 99152 and 99153 under Dr. A or do I bill 99152 twice? 99152 once under Dr. A and again under Dr. B?

Thank you in advance for your help or suggestions on where to look for an answer.

Sincerely,

Margaret
 
Margaret Morgan said:
Good morning,

I have a question regarding the new moderate (conscious) sedation codes; which has always been bundled with the catheterization and other procedure codes. I have been educating myself to be ready in January. I think I have the basics down, however I have question about coding sedation when 2 procedures by two different physicians is performed during the same session.

an example is 65 year old patient has crushing chest pain and diagnostic catheterization is performed by doctor A. critical blockage is found but Doctor A is diagnostic cardiologist and doesn't have the training to perform the intervention to place a coronary stent to open up the blockage. Doctor B, an interventional cardiologist is called in and takes over the case. Doctor A leaves and Doctor B places a stent to open blockage. Too make this easier for me to understand, let’s say each procedure took 15 minutes.

My question, how do I bill the sedation? Is it billed under Dr. A? Or is it split between the two providers? Do I bill 99152 and 99153 under Dr. A or do I bill 99152 twice? 99152 once under Dr. A and again under Dr. B?

Thank you in advance for your help or suggestions on where to look for an answer.

Sincerely,

Margaret
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Are the doctors in the same group? If not, I see problems (I think)

Jim Pawloski, CIRCC
 
moderate sedation

I think I would bill the base code twice and use modifier XP for separate physicians.

Megan Casarez, CPC, CIRCC
 
Jim,
They are both in the same group.

Megan,
You make a good point with the XP modifier, but I am concerned about the documentation requirements if that happen, which it will with my physicians. I guess I will have to stress that if you take over a patient that sedation clock has reset to zero. Jim, do you agree?

Thank you both for your help. I posted this question in the anesthesia forum and did not have a response. A 114 views with no opinion rendered.

Sincerely

Margaret Morgan, CPC, CIRCC​
 
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