Ask the Expert

This month’s selection:

Do you have any clear advice on how to use the new Anesthesia codes 99151–99157? Our office uses qualified nursing staff when performing moderate (conscious) sedation. We were coding the drug administration codes for the nursing staff as they were administering the medications when the procedures are being performed on an outpatient basis prior to the new codes for 2017.

Now, with the new codes added, my take is that we can eliminate the administration codes and now use the new CPT codes provided for moderate conscious sedation. These codes could now be used by the qualified nursing staff when they’re in attendance during the procedure for monitoring the anesthesia care, which would start at the administration of the sedation and end when the procedure has been completed.

Mary C. Kubacki, CPC

Response:

The short answer is, yes, the questioner can and should be using the new conscious sedation CPT codes for the services described.

Moderate sedation is reported and paid separately, when medically necessary and properly documented. When a different provider performs the primary procedure and the moderate sedation, the appropriate codes are as follows:

• 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. … initial 15 minutes of intraservice time, patient age 5 years or older; and

• 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).

In these cases, the provider performing the moderate sedation (not the provider performing the primary procedure) will bill for the moderate sedation. No independent observer is necessary to monitor the patient.

When the same provider performs the primary procedure and the moderate sedation, the appropriate codes are as follows:

• 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. … initial 15 minutes of intraservice time, patient age 5 years or older; and

• 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).

Although the provider performing the primary procedure and the moderate sedation will report the moderate sedation, there must be a trained observer to assist. Per CPT guidelines, the minimum time requirement to report moderate sedation is 10 minutes; at least seven minutes must pass to report an additional unit.

For example: A patient is 3 years old, and different providers perform a primary procedure and moderate sedation. Total intraservice time for the sedation is 44 minutes. Coding for the moderate sedation is 99155 (first 15 minutes of intraservice time), 99157 x 2 (minutes 16–30 and 31–44).

Medicare Rules Differ
The Centers for Medicare & Medicaid Services (CMS) states that the moderate sedation work for certain esophageal dilation, biliary endoscopy, and endoscopic retrograde cholangiopancreatography procedures differs from that of other endoscopy procedures. For this reason, CMS created a gastrointestinal endoscopy-specific moderate sedation 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 intraservice time; patient age 5 years or older). Report G0500 instead of 99151–99152 when reporting moderate sedation to Medicare patients, in addition to designated gastrointestinal endoscopy services. For additional details and a full list of designated gastrointestinal endoscopy services, see Table 26 of the 2017 Medicare Physician Fee Schedule Final Rule.

When reporting G0500 to Medicare, report intraservice time beyond the initial 15 minutes using 99153, as appropriate.

— John Verhovshek, MA, CPC, is managing editor for AAPC.