07-04-2017, 05:55 AM | Community Wiki

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help witht he new 2017 moderate sedation codes

  1. Default help witht he new 2017 moderate sedation codes
    Medical Coding Books
    Good morning,

    I have a question regarding the new moderate (conscious) sedation codes; which has always been bundled with the catheterization and other procedure codes. I have been educating myself to be ready in January. I believe I understand the basics, however I have question about coding sedation when 2 procedures by two different physicians is performed during the same session.

    an example is 65 year old patient has crushing chest pain and diagnostic catheterization is performed by doctor A. critical blockage is found but Doctor A is diagnostic cardiologist and doesn't have the training to perform the intervention to place a coronary stent to open up the blockage. Doctor B, an interventional cardiology is called in and takes over the case. Doctor A leaves and Doctor B places a stent to open blockage. Too make this easier for me to understand, let’s say each procedure took 15 minutes.

    My question, how do I bill the sedation? Is it billed under Dr. A? Or is it split between the two providers? Do I bill 99152 and 99153 under Dr. A or do I bill 99152 twice? 99152 under Dr. A and again under Dr. B?

    Thank you in advance for your help or suggestions on where to look for an answer.

    Sincerely,

    Margaret

  2. #2
    Location
    Farmers Branch, Tx Local Chapter
    Posts
    25
    Default New 2017 Sedation Codes
    Hello Margaret.

    The new moderate sedation codes for 2017: 99151, 99152, 99153 would be used when the same MD or NPP provides the sedation as well as performing the procedure. Different MD/NPP providing the Moderate Sedation would be: 99155, 99156, 99157.

  3. #3
    Location
    Farmers Branch, Tx Local Chapter
    Posts
    25
    Default Addendum to New 2017 Moderate Sedation Codes
    Margaret,

    I also should have added this valuable information, which I just found in the front section of AMA CPT Professional 2017 under Anesthesia Guidelines section with reference to Moderate Sedation codes for 2017, page 54. When a second physician other than the health care professional performing the diagnostic or therapeutic services provides moderate (conscious) sedation in the facility setting (eg, hospital, outpatient hospital/ ambulatory surgery center, skilled nursing facility), the second physician reports the associated moderate sedation procedure/service 99155, 99156, 99157; when these services are performed by the second physician in the nonfacility setting (eg, physician office, freestanding imaging center), codes 99155, 99156, 99157 would not be reported.

    I just wanted to make sure you have all the information you need for Moderate Sedation Coding.

  4. Default
    Thank you for your information. I make sure I understand, Dr. A starts the procedure and directs sedation for 15 minutes. He turns over the case to Dr. B and leaves the surgery suite. Dr. B, based on the findings from Dr. A procedure, who does a different procedure, which takes additional 15 minutes. Pt. age 60 years old.

    Dr. A billed 99152
    Dr. B billed 99152

    Happy New year
    Margaret

  5. Default Facility vs Non-Facility for Conscious Sedation 2017 codes
    If a provider bills for 30 minutes of conscious sedation in a facility can he only report the 99152? Per CMS the 99153 has a PCTC indicator of 3 which means that it is only billable by the facility.

  6. Default mrce@tampabay.rr.com
    Can anyone tell me if the new sedation codes (99151-99157) can be assigned when only total time is documented, as opposed to start/stop time?

    If a patient is seen in a hospital outpatient setting and the documentation reads total sedation time 20 minutes. The documentation does not indicate start/stop time.

    Debra

  7. Default
    I am also looking for an answer to this... the guidelines say
    "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."

    So that would mean that if the health care professional from the OR hands the patient off to a recovery nurse, my time ends at the hand off.... the recovery nurse should fall into the 'post service' category - right?


    Quote Originally Posted by mrcedferenc View Post
    Can anyone tell me if the new sedation codes (99151-99157) can be assigned when only total time is documented, as opposed to start/stop time?

    If a patient is seen in a hospital outpatient setting and the documentation reads total sedation time 20 minutes. The documentation does not indicate start/stop time.

    Debra

  8. Default
    Quote Originally Posted by MJohnsonMartinez View Post
    I am also looking for an answer to this... the guidelines say
    "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."

    So that would mean that if the health care professional from the OR hands the patient off to a recovery nurse, my time ends at the hand off.... the recovery nurse should fall into the 'post service' category - right?
    Yes that is correct your time ends when the patient goes to recovery, and if the doctor dictates the 20 minutes instead of the start and stop time you
    can bill the conscious sedation.

  9. #9
    Location
    Whittier Chapter
    Posts
    26
    Default documentation on Colonoscopy report
    Margaret,

    Do you suggest that provider that performed both sedation/procedure document on op-report as: Anesthesia: moderate sedation?


    I can't find guideline that will say ya or na?

    Mary

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