Timing for moderate sedation

kewing

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When billing moderate sedation, does the amount of time need to reach the halfway point specified in CPT in order for the code to be billed? For instance, if the time is stated as 35 minutes, would that be billed 99144 or 99144+99145? Also, if you can give me a reference I would appreciate it. I vaguely recall reading something about a clarification on this issue, but don't remember the source.
Thanks for your help.
 

dwaldman

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rcrosse
New Join Date: Apr 2007
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Moderate/Conscious Sedation Question

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We are new to moderate sedation coding and are trying to figure out if we can bill for sedation when the case is shorter than 30 minutes since the procedure code reads "First 30 Minutes". We also need to know if we can bill for less than 15 minutes additionally. We bill general anesthesia based on 1-15 minute increments, but did not know if this also applied to moderate sedation. If anyone has or can point me in the direction of proper guidelines, I would really appreciate the information.

Rhonda Crosse, CPC


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#2 03-25-2009, 11:03 AM
CathyO
Contributor Join Date: Apr 2007
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moderate sedation

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Since the code for moderate sedation is not an anesthesia code, you would not follow the same guidelines as anesthesia. The first moderate sedation code is basically stating "up to" the first 30 minutes. The additional code is also "up to" the next 15 minutes. And if it passed an additional 15 minutes, you would code it again. (ex: If it was an hour, 18 yr old pt, you would code 99144, 99145x2). I believe I am correct, unless anyone else would like to suggest otherwise.
 

dwaldman

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In my previous post, I searched AAPC forums using the search function under keywords99144. There was a similiar Q and A that I copied and pasted. Below is from another coding forum that I found on internet search I did.

http://www.unicormed.com/CS/forums/300/ShowPost.aspx


From information given at the CPT 2006 Symposium, Nov. 17-18, 2005, in Chicago by the AMA. Stanley W. Stead, MD,MBA, American Society of Anesthesiologists:

"Question: How should I report a Moderate Sedation on an adult with an independent observer that lasts 35 minutes?

Answer: 99144, +99145."

In the example above there were 5 minutes abouve the 30 minutes for code 99144.. ..the answer seems to indicate that +99145 means "up to" 15 minutes additional time. Hope that helps.
 

kewing

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timing for moderate sedation

In answer to my previous posting, I have now come across the reference that I needed for coding moderate sedation based on time. In the 2011 CPT on page xii the instructions say, "...A unit of time is attained when the mid-point is passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and sixty minutes)." Based on this 99144 can be billed for 16-37 minutes. 99145 can be billed after 38 minutes up to 52 minutes.
 
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