FDA Approves Label Changes for General Anesthetic and Sedation Drugs

by | May 25, 2017 | Medical Coding News, Resources | 0 comments

Anesthesiology medical billing can be complex as service providers must follow stringent federal guidelines. Pediatric anesthesia services were in the news lately when the American Medical Association (AMA) announced that moderate sedation, when performed and properly documented, may be reported separately. In previous years, the AMA and the Centers for Medicare and Medicaid (CMS) disallowed separate reporting of moderate sedation in many situations. About 450 CPT codes were valued to include moderate sedation when performed. As of Jan. 1, 2017, CPT no longer defines moderate sedation as an inherent part of any procedure. The FDA has now approved labeling changes regarding the use of general anesthetic and sedation medicines in young children.

FDA Approves Label Changes for General Anesthetic and Sedation Drugs in Young Children

The most common type of anesthesia for children having a surgery is general anesthesia. In December 2016, the U.S. Food and Drug Administration had issued a warning that repeated or lengthy exposure to general anesthesia may harm brain development in children under 3. Anesthesiology News reported on the FDA approval of labeling changes regarding the use of general anesthetic and sedation medicines in children younger than 3 years. The key changes are as follows:

  • A new warning stating that exposure to these medicines for lengthy periods or over multiple surgeries or procedures may negatively affect brain development in children younger than 3 years.
  • Addition of information to the sections of the labels about pregnancy and pediatric use to describe studies in young animals and pregnant animals that showed exposure to general anesthetic and sedation drugs for more than three hours can cause widespread loss of nerve cells in the developing brain.
  • Studies in young animals suggested these changes resulted in long-term negative effects on the animals’ behavior or learning.

Young children, pregnant women, and other patients who require surgery or other painful and stressful procedures require general anesthetic and sedation drugs.

The FDA advises that:

– Pregnant women should not delay or avoid surgeries or procedures during pregnancy, as doing so can negatively affect themselves and their infants
– Surgeries or procedures in children younger than 3 years should not be delayed or avoided when medically necessary.
– Consideration should be given to delaying potentially elective surgery in young children where medically appropriate.

While general anesthesia medications cause sleep, moderate (or conscious) sedation is a drug-induced depression of consciousness, which may be administered during colonoscopy, cataract removal, or dental procedures. In moderate sedation, patient stays relaxed and insensitive to pain, but will be conscious and able to respond to verbal instruction.

Moderate Sedation Code Changes for 2017

Skilled coders will use the latest medical billing codes properly to help providers avoid denials and delays. In 2017, they will ensure that moderate sedation is reported separately using the new CPT codes. The coding changes for 2017 are as follows:

  • Prior moderate sedation (99143-99150) CPT codes have been deleted and have been replaced by six new CPT codes that are assigned based on who performs the moderate sedation, that is, the same provider who performs the primary service, or another provider, patient age (5 years or younger, or older than 5 years); and, intraservice time of the moderate sedation.
  • The six moderate sedation CPT codes for 2017 are: 99151, 99152, 99153, 99155, 99156, and 99157. These are to be used when administering moderate sedation with each procedure.

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 (to be listed 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 (to be listed separately in addition to code for primary service)

HCPCS Code G0500

Based on the reasoning the moderate sedation work for certain esophageal dilation, biliary endoscopy, and endoscopic retrograde cholangiopancreatography (ERCP) procedures differs from that of other endoscopy procedures, CMS augments the new moderate sedation CPT codes with a gastro-intestinal (GI) endoscopy-specific moderate sedation code, G0500.

HCPCS 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 intra-service time; patient age 5 years or older.

Coding for Moderate Sedation — Points to Note

  • Codes 99151-99157 are applicable to report administration of medications for pain control, minimal sedation, deep sedation, or monitored anesthesia care (00100-01999)
  • Codes 99151- 99157 include pre, intra, and post-service work associated with MS services
  • 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
  • CPT defines intraservice time as beginning with the administration of the sedation agent, and ending when the procedure is completed, the patient is stable for recovery status, and the provider performing the sedation ends personal continuous face-to-face time with the patient
  • The CPT manual includes a chart to providers determine the proper number of units of moderate sedation to report, based on intraservice time

Using new CPT codes to report moderate sedation services in 2017 will ensure greater accuracy and prevent double-billing in situations where a moderate sedation service is provided by a second provider. At the same time, services for which moderate sedation was previously considered intrinsic, such as interventional, electrophysiology and some echocardiography procedures, will be reduced. These coding changes have brought about new billing and workflow requirements. For pediatric anesthesia service providers, partnering with an experienced medical billing and coding company is the best way for providers to ensure error-free claim submission and maximum reimbursement.