Moderate Sedation codes

erinal

Contributor
Messages
24
Location
Tulsa
Best answers
0
I work for a pain management clinic and we do various procedures (injections, kyphoplasty's, SCS) in which we will give the patient moderate sedation services but I want to make sure we are billing for it appropriately. I understand that with the new moderate sedation codes they are in 15 minute increments. So my first question is, how many minutes does the patient need to be monitored in order to bill both the 99152 AND 99153. From my understanding you can bill 99152 if the patient is monitored for at least 10 minutes. So in order to bill for the 99153 (additional 15 minutes) does the patient need to be monitored for the first 15 minutes (to satisfy 99152) and then an additional 10 minutes to qualify for that second code (99153)?

Also, I noticed in the "Includes" section for the code 99152 it states "Intraservice work that begins with the administration of the sedation drugs and ends when the procedure is over". Does this mean that we can only bill from the time the medication is pushed to the time that the procedure is over?? I ask because we monitor the patient's for at least another 10-15 minutes after the procedure is done. We document start and stop times for the monitoring of the patient whilst under moderate sedation.

Thanks in advance!​
 

sarab86

Guru
Messages
116
Location
Fort Myers, FL
Best answers
0
Im interested to see who else is using these too. We have been and turned out that CMS made an Edit for the sedation codes with modifier not allow so we aren't getting paid for it. We have reached out to KZA but have had no response yet.
 
Messages
250
Location
Albany
Best answers
0
See page 678 in CPT book for a guideline on moderate sedation times. Remember moderate sedation begins intraservice.

99152 can be billed for 10-22 total minutes of sedation
99153 can be billed for 23-37 minutes - this is an add on code to 99152
99153 x 2 is for 38-52 minutes of sedation.

Also Medicare made an error and is denying 99153. Medicare's system will be updated on 4/1/17 so you will need to rebill these codes then for payment.

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

jweidman

Contributor
Messages
10
Location
Chester, VA
Best answers
0
99152 and Medicare

Thanks for the info on Medicare and 99153. We received denials for saying it can only be billed by facility with TC. Also, we were only getting paid $1 for 99152. I was told by one of the Medicare insurance processors in our office that the payment has increased but it is still about $20 less than we were getting paid for the 99144. Any additional information is appreciated.
 

bericson

Guest
Messages
10
Location
Salt Lake City, UT
Best answers
0
Check out John's Article

I work for a pain management clinic and we do various procedures (injections, kyphoplasty's, SCS) in which we will give the patient moderate sedation services but I want to make sure we are billing for it appropriately. I understand that with the new moderate sedation codes they are in 15 minute increments. So my first question is, how many minutes does the patient need to be monitored in order to bill both the 99152 AND 99153. From my understanding you can bill 99152 if the patient is monitored for at least 10 minutes. So in order to bill for the 99153 (additional 15 minutes) does the patient need to be monitored for the first 15 minutes (to satisfy 99152) and then an additional 10 minutes to qualify for that second code (99153)?

Also, I noticed in the "Includes" section for the code 99152 it states "Intraservice work that begins with the administration of the sedation drugs and ends when the procedure is over". Does this mean that we can only bill from the time the medication is pushed to the time that the procedure is over?? I ask because we monitor the patient's for at least another 10-15 minutes after the procedure is done. We document start and stop times for the monitoring of the patient whilst under moderate sedation.

Thanks in advance!​

John Verhovshek wrote an article that included how to handle this.

https://www.aapc.com/blog/36784-moderate-sedation-bundles-no-more/
 
Top