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Conscious Sedation Billing

  1. #1
    Question Conscious Sedation Billing
    Medical Coding Books
    Good morning all,

    We are having some discussion in our office about the appropriate calculation of conscious sedation time. We know that 99144 is for the "first 30 minutes" and 99145 is for "each additional 15 minutes". So 10:00-10:45 would be 99144 & 99145x1. But what about the following scenarios: 10:00-10:25, 10:00-10:37, 10:00-10:52. Do you have to have an additional full 15 minutes before billing an extra unit of 99145? That is what I always thought, but now am starting to question.

    If anyone knows the proper way to handle this and/or where to find any guidelines in writing, it would be greatly appreciated.

    Thanks in advance.

  2. #2
    Default conscious sedation
    Quote Originally Posted by schuchmanb View Post
    Good morning all,

    We are having some discussion in our office about the appropriate calculation of conscious sedation time. We know that 99144 is for the "first 30 minutes" and 99145 is for "each additional 15 minutes". So 10:00-10:45 would be 99144 & 99145x1. But what about the following scenarios: 10:00-10:25, 10:00-10:37, 10:00-10:52. Do you have to have an additional full 15 minutes before billing an extra unit of 99145? That is what I always thought, but now am starting to question.

    If anyone knows the proper way to handle this and/or where to find any guidelines in writing, it would be greatly appreciated.

    Thanks in advance.
    10:00-10:25 would be 99144 (this lists as first 30 minutes, it does not indicate 'must be 30 minutes' in the description) and I take this to mean up to and including 30 minutes.
    10:00-10:37 and 10:00-10:52 (see CPT assistant Feb 2006 pages 10-15 coding consultation moderate conscious sedation) and these same scenario's are described.
    10:00-10:37 would be 99144 and 99145 x 1
    10:00-10:52 would be 99144 and 99145 x 2
    The each additional 15 minutes would be up to and including the 15 minute mark, at 16 minutes then you would use an additional unit.

    Anyone else have a different interpretation? Thanks

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