Is it ok to bill 99152 in an office setting?

chrysel

Contributor
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I am receiving denials stating "procedure code inconsistent with POS" and then M77 which is for either invalid or missing modifier. It was billed as POS 11 and TOS 1. Any suggestions on how this needs to be sent. Any help is appreciated.

Thanks
Chrysel
 

Chelle-Lynn

True Blue
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Modesto, CA
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  • Time is based on intra-service time, which begins with the administration of sedating agents.
  • Moderate sedation is administered through an IV to a patient 5 years or older who is undergoing a procedure. The patient is monitored by an observer.
  • Moderate sedation must be reported separately to receive reimbursement.
  • The service may be reported in a non-facility or facility setting
 

chrysel

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This was for a patient older than 5 years for 15 minutes in an office setting. I'm not sure why this is getting and its more than one claim.
 

tward01

New
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Warrenton, VA
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Moderate sedation denied in office POS 11

We received the same denial of 99152 and invalid place of service. I spoke with Medicare this morning and the representative states that 99152 is only valid for inpatient and outpatient out-of-office settings such as ASC, off-campus outpatient facility, etc. and cannot be billed with the POS 11. My denials are all related to spinal epidural steroid injections (LESI, RFA, etc). I am unable to find any literature regarding to the places of service allowed for this code. Can someone direct me to that specific information? I have received payment from our local BCBS and UHC, just not Medicare.

Thanks in advance!
 

chrysel

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I have the exact same problem, denial from Medicare. Commercial payors are paying 99152 just fine. I was unable to find any documentation stating where we can bill and where we cannot. Anyone who knows where I could find this information...please help.
Thanks
Chrysel
 

tward01

New
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Warrenton, VA
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I just got notification from Palmetto GBA 99152-99153 are being denied when billed with POS 11. A system request has been submitted to allow for POS 11. Once it is actually updated, we can resubmit the claims for payment.

Sounds to me like the just realized their error and it's being worked on. Hopefully it won't take months for it to get resolved!
 
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Albany
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We bill moderate sedation in the office and I have received payment on 99152. However, 99153 denies with an edit error that will be updated in April 2017. Make sure your documentation the intraservice time billed.


Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management
 
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