Wiki Sedation codes

[aekenyon87]

If patient has total moderate sedation time of 22 minutes, would correct coding be 99152 & 99153? I'm being told to replace 99152 with 99153 after receiving denial from an insurance company. But I thought 99153 was an add-on code, so it cannot be billed by itself?

 

[Mayzoo]

CPT chart (pg 697 of 2018 CPT code) states 10-22 minutes of moderate conscious sedation is coded with 99151 if patient is under 5 years of age, and 99152 if patient is 5 years or older.

You are right, add on codes cannot be coded alone. There is also no need to use 99153 since you are within the time frame of 99151 or 99152.

 

[aekenyon87]

Thank you!