In the last article I wrote about coding for sedation services. I briefly touched on the coding and reporting requirements for moderate sedation. In this article, I will elaborate on that and provide a breakdown of what is needed to report these services.
In 2017 the codes for physician reporting of moderate or conscience sedation changed from 99144 and 99145 to 99151-99157, with most practices utilizing 99152 which is defined as: Moderate sedation service provided by the same physician or other qualified healthcare professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient s level of consciousness and physiological status, initial 15 minutes of intraservice time, patient age 5 or older and 99153 each additional 15 minutes intraservice time.
Notably the description of these codes changed. 99144 was used to report the first 30 minutes of sedation services. The replacement code 99152 is used to report the first 15 minutes of sedation. This brings us to time reporting. When reporting time, the provider must meet a minimum amount of the total time increment to report. When using a code described as “first 15 minutes” the service has to be recorded as being at least 10 minutes in length to qualify.
If the service was less than that length, it may not be billed. For 99153, each additional 15 minutes, the minimum time recorded must be 7 minutes. Taking the example further, if a patient has been recorded as being under moderate sedation for a total of 47 minutes, this would be coded as 99152 for one unit and 99153 for 2 units. The last 2 minutes are not reportable because they do not meet the half way rule.
Another key element to consider is that only intra-service time is reportable. Pre-service and post-service work is expected and included in the payment for the code billed. Intra-service time begins when the sedating agent is administered. It ends when the procedure is completed, the patient is in stable recovery, and the physician providing the sedation service ends continuous face-to-face time.
The last thing to take into consideration is who is performing the service and under what supervision. Moderate sedation billed by the provider performing the surgical service requires that an independent and qualified clinician be monitoring the patient while under the direct supervision of the physician.
CPT goes into further detail, with reporting examples and a complete description of preservice and post service work. It is recommended that this be reviewed carefully prior to billing to ensure an understanding of the requirements.
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