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Moderate Sedation Coding

Moderate sedation is a part B covered service, with administration by the physician performing the procedure. Moderate sedation is not a hospital outpatient or ASC clinical staff service, so the coding/billing is completed by doctor as a professional fee.<br>

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Moderate Sedation Coding

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  1. Moderate Sedation Coding Moderate Sedation A drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or amid by light tactile stimulation. Moderate Sedation also referred as conscious sedation, is a drug-induced depression of consciousness. A patient who has been sedated in this way is relaxed and customarily insensitive to pain, but remains awake and ready to reply to verbal instruction. If medically necessary and properly documented, moderate sedation is a service that is separately reported. Three primary factors for moderate sedation to code: Different Provider Administration Whether the similar provider is both administering the sedation and performing the procedure that the sedation is required. Coding changes when a distinct provider administers the sedation. If a special provider, aside from the provider performing the primary procedure, administers the moderate sedation, an independent observer isn’t required. www.medicalbillersandcoders.com Copyright ©-2020 MBC. All Rights Reserved Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com 1

  2. Patient Age Whether the patient is younger than five years of age; or five years old, or older. Intraservice Time The “intraservice time” of the procedure. Intraservice time begins with the administration of the sedation agent, and ends when the procedure is completed, the patient is stable for recovery status, and also the provider performing the sedation ends personal continuous face- to-face time with the patient. Per CPT Assistant (May 2017), “the time spent on postservice activities that are required for moderate sedation aren’t included when calculating time and selecting the appropriate moderate sedation codes.” The CPT® codebook includes a helpful chart to determine the proper number of units of moderate sedation to report, based on intraservice time. CPT Codes for Moderate Sedation The six code you’ will us to report moderate sedation, with full descriptors, are as follows: Code 99151 Moderate sedation services 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 help within the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age Code 99152 …initial 15 minutes of intraservice time, patient age 5 years or older Code 99153 Moderate sedation services 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; each additional 15 minutes intraservice time (list separately in addition to code for primary service) www.medicalbillersandcoders.com Copyright ©-2020 MBC. All Rights Reserved Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com 2

  3. Code 99155 Moderate sedation services provided by a physician or other qualified healthcare professional other than the physician or other qualified healthcare professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age Code 99156 … initial 15 minutes of intraservice time, patient age 5 years or older Code 99157 Moderate sedation services provided by a physician or other qualified healthcare professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes intraservice time (List separately in addition to code for primary service) Can Physician bill for the Moderate sedation service? Moderate sedation is a part B covered service, with administration by the physician performing the procedure. Moderate sedation is not a hospital outpatient or ASC clinical staff service, so the coding/billing is completed by doctor as a professional fee. It is the physician associated with moderate sedation. The registered nurse under supervision may push the drugs but that person's cost is an element of facility fee. Are you trying to find any assistance in Medical Billing and Coding? Reach out to us today at 888- 357-3226 or info@medicalbillersandcoders.com. www.medicalbillersandcoders.com Copyright ©-2020 MBC. All Rights Reserved Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com 3

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