Wiki Moderate (Conscious) Sedation (MSC)

abtorrez

Guest
Messages
4
Best answers
0
Hello,

I would like to ask for interpretation of the guidelines for MCS. We are having an ongoing debate as to what has to be included in the documentation before MCS is coded and billed. My understanding is that all three components preservice work, intraservice work, and postservice work has to be in the chart as proof all elements are met. I do know the pre and postservice are not reported separately, and not included in the intraservice time; only intraservice time counts from administration of the first sedative and ending when the procedure ends, the patient is ready for recovery, and face-to-face time ends.

The guidelines under preservice work indicate: The preservice activities required for moderate sedation are included in the work described by each of these codes 99151-99157. Is this an all components for pre, intra, and postservice should be accessible to the coder, if not sedation is not coded? The debate is if it really is the responsibility of the coder to ensure the work has been done, or are they allowed to code the intraservice work, without the pre-and post service documentation in the EHR?

Your feedback is greatly appreciated

ABT
 
There is mixed information out there about what is required in terms of documentation. AAPC is holding a webinar to give clarification on moderate sedation, but not until August. Here are some articles that talk about the documentation requirements, though none are from AAPC or AHIMA. The first two articles support documenting pre-service, intra-service, and post-service work. The last two articles focus on the intra-service component. Given the lack of clarity, I always advise to document more, not less. So I recommend that providers document pre-service, intra-service, and post-service work.

https://www.intermedix.com/blog/2017-cpt-update-lower-time-requirement-for-reporting-moderate-sedation
http://www.streamlinemd.com/Specialties/Pain/Blog/post/moderate-conscious-sedation---extensive-changes-for-2017
https://www.asge.org/docs/default-source/default-document-library/moderate-sedation-for-gi-services-lm-final-1-27-17.pdf?sfvrsn=0
https://www.supercoder.com/my-ask-an-expert/topic/conscious-sedation-documentation-requirements

Best of luck,

Jennifer M. Connell, CPPM, CPCO, CPMA, CPB, CPC, CPC-I, CPC-P, CENTC
 
MCS documentation

I have done additional research on MCS. I found that there are policies what information has to be collected, who can perform MCS, credentialing, and clinical information that has to be documented. I did look at our policy and procedures and found we do have a policy in place for MCS that reflects American Society of Anesthesiologists. In review of the policy it does require documentation of all the preservice work, intraservice, and post service, which for the most part is performed with every MCS procedure.

I did watch a webinar on Peripheral Cardiology coding for 2017. The webinar indicated, rather presenter, Terry Fletcher, there has to be an attestation by the same provider performing procedure and directing MCS. An acceptable attestation is when MCS is included in the procedure, the report should state "MCS was provided under my direct supervision with the sedation trained nurse using ___mg of IV ____and ____mg of IV___________. Start tune ______ and end time was ______. There were no complications. See nurses sedation sheet I signed and dated for completed pre and post service. :eek:)
 
Moderate Sedation Documentation

My question is in regards to the actual physician's procedure report in which the moderate sedation is needed. For example, if a physician is doing a heart cath and is going to charge the 99152 for the moderate sedation, is the physician required to document in the actual cath report that the patient was under moderate sedation? Or is the separate moderate sedation report enough?
 
In my experience, a separate report is enough. Most operative/procedure notes do not include any notes of sedation. Anesthesiology generally produces these notes.
 
Moderate Sedation 99152 and 99153

I would like to know if anyone knows why insurance would pay for 99152 performed in a hospital setting but not the subsequent code of 99153?

My doctors use the moderate sedation often and are only getting paid for the first 15 minutes but not anything past that.
 
Cath lab

We just opened a cath lab my question is
I will only be billing for the doctors component that being said
if they do a stent i wont be billing for that am i right?? because there is no TC or 26???
Thanks for your input
 
Top