Awareness : Did You Know?

Did You Know? Weekly Educational Series #4

For the Week of January 30, 2017-Conscious Sedation

In 2017, Moderate Sedation Codes 99143-99150 have been deleted.  They have been replaced with the following new codes 99151-99157.

  • 99151: Moderate sedation services provided by the same physician or other qualified health care 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 younger than 5 years of age.
  • 99152:  Moderate sedation services provided by the same physician or other qualified health care 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 younger than 5 years or older.
  • +99153:  Moderate sedation services provided by the same physician or other qualified health care 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) 
  • 99155: Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age.
  • 99156:  Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient age 5 years or older.
  • 99157: Moderate sedation services provided by a physician or other qualified health care 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)

The first three new codes in the range describe moderate sedation that the surgeon performs himself in addition to his procedure, while the second three codes describe moderate sedation that the surgeon performs for a procedure performed by someone else.

The intra-service time thresholds for moderate sedation have been reduced from 30 minutes in 2016 to 15 minutes in 2017.

Use G0500 with endoscopy: If The surgeon performs both a gastrointestinal endoscopy procedure and the moderate sedation for a Medicare patient aged 5 years or older, you should not use new CPT® code 99152 (Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that 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 years or older) for the conscious sedation. 

Instead, you should bill the moderate sedation using HCPCS code G0500 (Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that 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 intra-service time; patient age 5 years or older [additional time may be reported with 99153, as appropriate]).

Understand Intra-service Time

Generally, CPT® instructs that for any time-based code, a unit of time is attained when the midpoint is passed, unless there are code- or code range- specific instructions to the contrary in the guidelines, parenthetical instructions, or code descriptors. In a new section-instruction chart, CPT® 2017 tells you not to bill a moderate sedation code if the intra-service time is less than 10 minutes — which overrides the standard “midpoint” time of 8 minutes for a 15 minute code.

Also new in the 2017 moderate sedation preamble are extensive descriptions of what the pre-, intra-, and post-service work periods include. You must follow these instructions if you want to choose the correct code — because only intra-service time counts towards the moderate sedation codes.

You should not include the following pre-service work components when determining intra-service time:

  • A thorough screening history involving assessment of the patient’s past medical and surgical history with particular emphasis on cardiovascular, pulmonary, airway, or neurological conditions, review of the patient’s previous experience with anesthesia or sedation and any family history of sedation compli¬cations, summary of the patient’s present medication list and any drug allergy and intolerance history.
  • A physical exam including focused emphasis on the mouth, jaw, oropharynx and airway for Mallampati score assessment, chest, lungs, heart and circulation, vital signs including oxygenation with end tidal CO2 when indicated.
  • A review of any pre-sedation diagnostic tests, completion of a sedation assessment form and obtaining informed consent
  • Starting IV access and fluids to maintain patency.

Similarly, you should not include the following post-service work components when determining intra-service times:

  • Assessment of the patient’s vital signs, level of consciousness, neurological, cardiovascular and pulmonary stability in the post-sedation recovery period
  • Assessment of the patient’s readiness for discharge
  • Documenting the sedation service
  • Communicating to family members or caregivers regarding the sedation service.

What can you count as intra-service time for the moderate sedation codes?

Intra-service time begins with the administration of the sedating agent. The requirements include, continuous face-to-face attention of the provider, and monitoring of the patient’s response to the sedation, periodic reassessments, and vital signs including oxygenation, heart rate, and blood pressure. The moderate sedation intraservice time ends when the procedure is completed, the patient is stable, and the provider performing the sedation ends personal face-to-face care of the patient.