CPT Coding Changes For Moderate Sedation in 2017

Dec 07, 2016

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As a result of the 2017 Physician Fee Schedule, moderate sedation will be separately billed and paid starting in 2017 using new CPT® codes. Services for which moderate sedation was previously considered inherent will be accordingly reduced. This includes many interventional, electrophysiology and some echocardiography services. While this creates greater accuracy and prevents double-payment in instances where a moderate sedation service is provided by a second provider, it creates new billing and workflow requirements.

Starting in 2017, Moderate Sedation CPT Codes 99151, 99152, 99153, 99155, 99156, 99157 should be used when administering moderate sedation with each procedure.

Table 1: Example of coding change from 2016 to 2017

2016

2017
  • Single CPT code:
    • 92928 (percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch)
  • Multiple CPT codes:
    • 92928 (percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch) AND
    • One or more of the new moderate sedation codes 99151- 99157 (such as 99152 and +99153 or 99156 and +99157)*

*There is a table for the new codes, based on time and age, in the 2017 CPT book.

Table 2: New CPT Codes For 2017

Code

Description

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 age 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)

Additional Coding Tips For Moderate Sedation

  • Codes 99151- 99157 are not used to report administration of medications for pain control, minimal sedation, deep sedation, or monitored anesthesia care (00100-01999)
  • An independent trained observer is an individual who is qualified to monitor the patient during the procedure, who has no other duties (i.e., assisting at surgery) during the procedure
  • Codes 99151- 99157 include pre, intra, and post-service work associated with MS services
  • Moderate sedation codes 99143 – 99150 have been deleted
  • Check the 2017 CPT book for greater detail

Keywords: Anesthesia, Current Procedural Terminology, Deep Sedation, Echocardiography, Fee Schedules


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