Wiki Moderate Sedation help

[Bea024]

Looking for specific guidelines on billing for moderate sedation under 10 minutes. We are currently being advised to bill for 4 minutes of sedation which does not seem correct to myself and my coding manager. Any help and reference to specific guidelines that we can bring to their attention would be greatly appreciated. This is for interventional nephrology in an outpatient setting.

Thank you

 

[jkyles]

Hello,

You're right. In the CPT manual there's a chart after the codes that gives examples of how to report the codes based on time. That chart states that moderate sedation may not be reported separately for less than 10 minutes of intraservice time. The definition of intraservice time is included with the codes, but basically:

Intraservice time is used to determine the appropriate CPT code to report moderate sedation services:
Begins with the administration of the sedating agent(s);

Ends when the procedure is completed, the patient is stable for recovery status, and the physician or other qualified health care professional providing the sedation ends personal continuous face-to-face time with the patient;

 

[Bea024]

Thank you so much. I appreciate the clarification.