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Medical Coding

The document discusses new CPT codes and time rules for moderate sedation. Key points include: - New CPT codes have been introduced to report initial and additional 15-minute increments of intra-service time for moderate sedation. - The threshold for initial intra-service time to report a code has been lowered from 16 minutes to a minimum of 10 minutes. - The definition of intra-service time has been expanded and now includes ordering sedating agents, continuous monitoring, and supervision during the procedure.

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Harsha Vipin
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241 views

Medical Coding

The document discusses new CPT codes and time rules for moderate sedation. Key points include: - New CPT codes have been introduced to report initial and additional 15-minute increments of intra-service time for moderate sedation. - The threshold for initial intra-service time to report a code has been lowered from 16 minutes to a minimum of 10 minutes. - The definition of intra-service time has been expanded and now includes ordering sedating agents, continuous monitoring, and supervision during the procedure.

Uploaded by

Harsha Vipin
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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2017 Moderate Sedation New CPT Codes, Modified Time Rules,

Expanded Definition of Intra-Service Time


New CPT Code Ranges:
 Intra-service time required to report initial services 99151-99152-99155-99156 = 15 minutes
**Note the first threshold for coding initial moderate sedation = 10 minutes intra-service time.
 Additional 15 minutes increments are reported with add on codes 99153 & 99157

Modified Time Rules: New moderate sedation codes lower the threshold for initial Intra-service time from 16
minutes to a minimum of 10 minutes. (See CPT defined time table below)

 This is a departure from CPT guidelines for time based codes which states that a “unit of time is attained when
the mid-point is passed.” For example, an hour is attained when 16 minutes have elapsed more than midway
between zero and 30 minutes.
 A physician or qualified health care professional must perform 10 minutes of intra-service time to report the
initial moderate sedation code.
 If less than 10 minutes there is no separate billable moderate sedation code and time would be considered part
of the procedure.
Examples of how reported:
10-22 minutes would be reported with initial service code 99152. (One 15 minute unit, plus 8 minutes & would
not have enough to code for additional 15 minute)
23-37 minutes would be reported with the initial service 99152 and one unit of 99153. (Two 15 minute units, plus
7 minutes would not have enough to add another additional unit of 15 minutes.)

CPT Moderate Sedation Time Table


Total Intra-service Time Patient age CPT Code(s)=Same CPT Code(s)=Different
physician performing physician who is performing
procedure procedure
Less than 10 minutes Any Age Not reported separately Not reported separately
10-22 minutes < 5 years 99151 99155
10-22 minutes 5 years or older 99152 99156
23-37 minutes < 5 years 99151 + 99153 x1 99155 + 99157 x1
23-37 minutes 5 years or older 99152 + 99153 x1 99156 + 99157 x1
38-52 minutes < 5 years 99151 + 99153 x2 99155 + 99157 x2
38-52 minutes 5 years or older 99152 + 99153 x2 99156 + 99157 x2
53-67 minutes < 5 years 99151 + 99153 x3 99155 + 99157 x3
53-67 minutes 5 years or older 99152 + 99153 x3 99156 + 99157 x3
68-82 minutes < 5 years 99151 + 99153 x4 99155 + 99157 x4
68-82 minutes 5 years or older 99152 + 99153 x4 99156 + 99157 x4

MGA Reference 1
Expands Definition of Intra-Service Time:
 Time Begins with the administration of sedating agents and
Time Ends when the physician or qualified health care professional finishes the procedure, the patient is ready
to go to recovery and the provider who performs moderate sedation ends “personal continuous face to face
time with the patient,” (When the physician leaves the room)
 Work that counts as intra-service time includes:
1. Ordering and/or administering sedating agents as needed
2. Requires continuous “Face to Face” attendance of physician or other qualified healthcare professional
3. Requires monitoring patient response to sedating agents to include:
o Periodic assessment of the patient;
o Further administration of agent(s) as needed to maintain sedation; and
o Monitoring of oxygen saturation, heart rate and BP
4. Supervising and directing an independent, trained observer when the provider performs procedure and
moderate sedation.
 Intra-service time does not include any pre-service work defined as Assessment of patient’s past
medical/surgical history with emphasis on cardiovascular, pulmonary, airway or neurological conditions; Review
of patient’s past experiences with anesthesia; family history of sedation complications; summary of patient’s
present medications; drug allergy and intolerance history; focused exam of patient with emphasis on mouth,
jaw, oropharynx, neck and airway for Mallampari score assessment; chest and lungs; heart circulation; Vital
signs; Review of any pre-sedation diagnostic tests; Completion of pre-sedation assessment form with ASA
Physical Classification status; patient informed consent; immediate pre-sedation assessment prior to first
sedating doses; and initiation of IV access and fluids to maintain patency.
 Intra-Service time does not include any post-service work defined as full patient assessment (vital signs, level of
consciousness, Neurological, Cardiovascular and Pulmonary stability in the post sedation recovery period;
Assessment for patient’s readiness for discharge to include preparing discharging documentation and
communication with family/caregiver regarding sedation service.

Documentation Requirement options for physicians:


o Total Intra-Service time = _______ minutes (document personal continuous face to face time with your
patient) OR
o Intra-Service start time: ___________ Intra-Service stop time: ___________

CPT Descriptions and 2017 RVU values:


CPT Description Total
Code RVU’s
99151 Moderate Sedation, same physician performing the procedure, initial 15 minutes, < 5 0.67
years; Total Intra-Service Time 10-22 minutes
99152 Moderate Sedation, same physician performing the procedure, initial 15 minutes, 5 years 0.35
or older; Total Intra-Service Time 10-22 minutes
99153 Moderate Sedation, same physician performing the procedure, each additional 15 0.31
minutes;
99155 Moderate Sedation, other physician performing the procedure, initial 15 minutes, < 5 2.63
years; Total Intra-Service Time 10-22 minutes
99156 Moderate Sedation, other physician performing the procedure, initial 15 minutes, 5 years 2.15
or older; Total Intra-Service Time 10-22 minutes
99157 Moderate Sedation, other physician performing the procedure, each additional 15 minutes 1.63

MGA Reference 2

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