Physician Practice

2017 CPT update overhauls moderate sedation reporting

Physician Practice Insider, March 21, 2017

Coders prepared for 2017 with numerous changes to the Official Coding Guidelines for the ICD-10-CM and the addition of many new codes. Quietly waiting in the wings was the updated CPT® Manual for 2017 with its changes waiting to be discovered.

The moderate sedation codes live in the same Medicine subsection as previous years, however 99143-99150 have been deleted and replaced with 99151-99157. Looking at these new codes in more depth, the definitions are similar. Prior to 2017, codes 99143, 99144, and 99145 identified moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service and further specified by age of patient and intraservice time. The new codes for moderate sedation provided by the same physician are 99151, 99152, and 99153, differentiated by the age of the patient. However, the intraservice time has decreased from the initial 30 minutes to 15. Additional intraservice time increments remain at 15.

The old codes for moderate sedation provided by a physician or other qualified healthcare professional other than the physician performing the procedure were 99148, 99149, and 99150, with the same specificity of patient age and intraservice time. These have been replaced with 99155, 99156, and 99157, with the intraservice time decreasing to an initial 15 minutes from 30.

Now that we know which codes to use for moderate sedation reporting, how are they reported? The guidelines for moderate sedation reporting are actually in two different areas of the manual, an important factor to remember when coding for these services.

Not only are there guidelines preceding the codes in the Medicine section, but there are a couple of paragraphs within the Anesthesia guidelines found at the beginning of the Anesthesia section of the CPT Manual. An important note in the moderate sedation guideline found in the Anesthesia section is regarding services performed by a second physician other than the physician performing the procedure. If moderate sedation is performed by the second physician in a non-facility setting such as a physician’s office or a freestanding imaging center, codes 99155-99157 would not be reported. This guideline is not repeated in the Medicine section, so it is important for coders to remember this when reporting these services.

This article originally appeared on Revenue Cycle Advisor. Members can read the full, detailed article here. To become a member, sign up here.

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