Moderate Sedation Codes in 2017 without anxiety or pain

Posted on 8 Aug, 2017 |comments_icon 0|By Elizabeth

As a result of the 2017 Physician fee Schedule if you bill for moderated sedation, this year just got easier for more than 400 procedures.

Last year you have noticed there’s something missing in your CPT manual about moderate sedation are now gone. From Old codes (99143-99150) have been replaced with a new batch (99151-99157).

These new moderate sedation codes lower the threshold for the required intra-service time from 16 minutes to minimum of 10 minutes. Now you’ll have to report the procedure code and the new moderate sedation codes. Wait there’s more, other big news is there would be No Requirement of Modifier 52 (reduced services) if you perform the procedure without moderate sedation.

There will be no requirement to keep track of which CPT code service and which don’t because in this year none of the codes include moderate sedation.

What does it look like in 2017?

It is important that key items are properly documented with this new moderate sedation codes to ensure proper coding. Your selection will be based on three criteria:

  1. Who provide the moderate sedation and procedures: May be the operating physician or a separate qualified healthcare practitioner.
  2. Age of Patient: Which can be obtained from anywhere in the chart.
  3. It’s all about Time: The length of “intraservice time” should be documented. The codes are in 15-minutes increment specific to the number of minutes, proposed range of time & to meet all payers requirement.

Additionally, the medical record should reflect the identity of the trained observer who was present when both the sedation and procedure were performed.

The most important part is that providers do not have to rely on the drug name to communicate whether moderate sedation was provided. The terms “moderate” or “conscious sedation,” in combination with “intraservice time,” should be used by provider to ensure the reader of the record understands that moderate sedation was performed and the time recorded was intraservice. It is important to note here that deep sedation is not reportable for these codes.





Elizabeth works on an array of projects at TCI, researching and writing about modern reimbursement challenges. Since joining TCI in 2017, she has also covered the nuts and bolts of cybersecurity, compliance with federal laws, and how to tap into the advantages of telehealth services.

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