Wiki Moderate Conscious Sedation coding

jeabie

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Hello,
Tt's been almost a year since the implementation of these codes, but I am still unsure of the guidelines. We bill 99152 only (we don't see kids). We billed 99153 at the beginning but then found out that it's a PC/TC code. The time is not an issue. What I'm not sure is the pre-service work that's required. In the book, there are 12 bullet points of pre-service work. Most of the times my doctors have them all in the H&P and Pre-Sedation evaluation. Once in a while they miss the Review of the patient's previous experiences with sedation complications (bullet #2) and Family hx of sedation complications (bullet #3), when this happens, I don't bill.
My question: Are they required to have every one of those 12 bullet points reviewed to bill 99152 (and other MCS codes)? Their H&P contains past medical and family histories as well, is this enough or do they have to specifically review bullet #2 and #3 separately. (page 676 on AMA CPT Book 2017)
I have been very strict with them... (for 1/4 RVU!!!), but when I read the internet, I don't seem to see any explanation. Just want to know what auditors think and how others do at their org.

Thanks a bunch!
 
Moderate Sedation

When it comes to the moderate sedation addition for 2017, the key to the directives you mentioned on Pg 676 of the AMA CPT is the sentence within the third paragraph that states,

"The following definitions are used to determine the intraservice time (compared to pre- and postservice time)".

The preservice work and postservice work defined in the CPT are there so you know what counts as intraservice work. The moderate sedation codes are defined by the intraservice work, so this is key in knowing what, during the procedure, you can bill for. I researched into this quite extensively back in January when the codes became billable and there isn't any guidance (that I know of) that states that you have to do each one of the pre- and postservice items listed to be able to bill for moderate sedation.
 
When it comes to the moderate sedation addition for 2017, the key to the directives you mentioned on Pg 676 of the AMA CPT is the sentence within the third paragraph that states,

"The following definitions are used to determine the intraservice time (compared to pre- and postservice time)".

The preservice work and postservice work defined in the CPT are there so you know what counts as intraservice work. The moderate sedation codes are defined by the intraservice work, so this is key in knowing what, during the procedure, you can bill for. I researched into this quite extensively back in January when the codes became billable and there isn't any guidance (that I know of) that states that you have to do each one of the pre- and postservice items listed to be able to bill for moderate sedation.

Thank you very much for your input. This is very helpful.
 
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