New 2017 Moderate Sedation CPT Codes to Impact Reimbursement across Multiple Specialties

CPT Codes to Impact ReimbursementCPT coding changes for moderate sedation (MS) in 2017 will impact reimbursement across various specialties. Outsourced medical billing companies are prepared for these changes that have created new billing and workflow requirements in practices. As a consequence of the 2017 Physician Fee Schedule, MS will now be separately billed and paid using new CPT codes.

The use of MS has increased vastly in recent times due to the popularity of minimally-invasive procedures. This type of sedation involves the use of pain relievers and sedatives to induce an altered state of consciousness. Moderate or conscious sedation is extremely safe and finds use in

  • Medical special procedures
  • Dental clinics
  • Emergency departments
  • Progressive care units
  • Critical care units
  • Echocardiology labs
  • Cardiac catheterization labs
  • Clinics (audiology, neurology)
  • Pre-operative holding areas

Qualified providers who can administered this form of sedation include Certified Registered Nurse Anesthetists (CRNAs), anesthesiologists, other physicians, dentists, and oral surgeons. Specially trained Registered Nurses may also assist in the administration of conscious sedation

Starting January 1, 2017 a complete revision of MS rules has come into effect which will impact coding and reimbursement from both private payers and Medicare. Six new codes have changed the way physicians report and get paid for the more than 400 services in different specialties that currently include this form of sedation. MS CPT Codes 99151, 99152, 99153, 99155, 99156, and 99157 should be used when administering moderate sedation with each procedure. Previously, MS reporting was linked to intraprocedure time and began with skin incision or vessel puncture. In 2017, this has changed so that the reporting time for MS begins with the first dose of sedative medication.

The American College of Cardiology gives the following example of the coding change from 2016 to 2017:

In 2016, a single CPT code was used for the administration of MS:

  • 92928 (percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch)

In 2017, the single code has been replaced by multiple codes: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)

A report in Endovascular Today provides further details of the important changes to reporting for (MS) services:

The new codes are classified in two groups:

  1. Sedation provided by the same provider who is performing the procedure (99151, 99152, 99153), and
  2. Sedation provided by a separate provider other than the one performing the procedure (99155, 99156, 99157)

Each of these groups is subdivided by age, and there are separate codes for:

  • patients aged younger than 5 years (99151, 99155)
  • patients aged 5 years and older (99152, 99156)

For patients of any age, each of the two main groups has one add-on code for each additional 15-minute increment of service (99153, 99157), which is used.

  • 99152 Initial 15 minutes of intraservice time, patient aged 5 years or older
  • + 99153 each additional 15 minutes of 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 aged younger than 5 years
  • 99156 Initial 15 minutes of intraservice time, patient aged 5 years or older
  • + 99157 Each additional 15 minutes of intraservice time

Physicians need to get up to date on MS codes and prepare for the new time requirements to ensure that they don’t miss out on revenue. Partnering with an experienced physician coding company could be the best way to achieve these goals.