Basics of Moderate Conscious CPT codes

Moderate conscious sedation is a drug-induced depression of consciousness which is used for performing surgeries. With moderate conscious sedation the patient responds purposefully to verbal commands. Interventional radiology and open surgery procedures requires moderate conscious sedation. The old CPT codes for conscious sedation 99143, 99144, 99145 have been deleted. We have now CPT code 99151, 99152, 99153, 99155, 99156 and 99157 for coding moderate conscious sedation from 2017. Be careful now,  since many of the CPT codes have been revised which will require to code sedation codes separately.

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Description of CPT code 99151, 99152, 99153, 99155, 99156 and 99157

The detail code description of CPT codes for moderate conscious sedation will help you to understand more about these procedure codes. Earlier we had only three CPT codes 99143, 99144, 99145 (deleted in 2017) which are used for coding sedation. But, now we  are having six CPT codes for coding moderate conscious sedation procedures. Below is the details description of these CPT codes.

A physician or other qualified health care provider administers medication that allows a decreased level of consciousness but does not put the patient completely asleep inducing a state called moderate (conscious) sedation. This allows the patient to breathe without assistance and respond to commands. This type of sedation is used for less invasive procedures and/or as a second medication for pain.

These codes report sedation services provided by the same provider performing the primary procedure with the assistance of an independently trained health care professional to assist in monitoring the patient. CPT code 99151 is reported for the first 15 minutes of intraservice time for sedation services rendered to a patient younger than 5 years of age. CPT code 99152 is reported for the first 15 minutes of intraservice time for sedation services rendered to a patient age 5 years or older. CPT code 99153 is reported for each additional 15 minutes of intraservice time.

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    initial 15 minutes of intraservice time, patient age 5 years or older

+ 99153 each additional 15 minutes intraservice time (List separately in addition to code for primary service)

CPT code 99155 is reported for the first 15 minutes of intraservice time for sedation services rendered to a patient younger than 5 years of age. CPT code 99156 is reported for the first 15 minutes of intraservice time for sedation services rendered to a patient age 5 years or older. CPT code 99157 is reported for each additional 15 minutes of intraservice time.

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  initial 15 minutes of intraservice time, patient age 5 years or older

+ 99157 each additional 15 minutes intraservice time (List separately in addition to code for primary service)

Moderate sedation codes 99151, 99152, 99153, 99155, 99156, 99157 are not used to report administration of medications for pain control, minimal sedation , deep sedation, or monitored anesthesia care (00100–01999). For coding correct procedure code, intraservice time of moderate sedation is used. For coding these codes, an independent trained observer who is qualified to monitor the patient during the procedure, should be present to monitor the level of consciousness.

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Changes with CPT code 99151, 99152, 99153, 99155, 99156 and 99157

Till 2016, most of the percutaneous or interventional radiology procedures include the moderate conscious sedation. For example, the Central venous catheter placement (36558-36571), chest tube placement (32551), stent and angioplasty procedure (37220-37231) etc. which used to include moderate conscious sedation till 2016. But, all these codes have been revised, which means the moderate conscious sedation has been excluded from these procedures. If you are using these codes you have to use CPT code 99151, 99152, 99153, 99155, 99156 and 99157 along with these procedure codes. Let us take an example for tunneled Central venous catheter placement without port and pump under fluoroscopic and ultrasound guidance with moderate conscious sedation by same physician of 45 minutes of a 50-year-old man, the CPT codes for this exam will be.

In 2017                                                     In 2016

Δ36558                                                      ☉ 36561

77001                                                       77001

76937                                                       76937

99152

99153×2

When imaging guidance is used for centrally inserted central venous catheters, for gaining access to the venous entry site and/or for manipulating the catheter into final central position, imaging guidance codes (eg, 76937, 77001) may be reported separately. Do not use 76937, 77001 in conjunction with 36568, 36569, 36572, 36573, 36584.

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How to find out new and revised CPT codes

The new codes will have dark circle (⚫) in front of the CPT code which tells that it is a new CPT code . The revised codes will have a triangle Δ  which will denote that the CPT codes is a revised code and the definition or description has been changed. So, be careful whenever you are using moderate conscious sedation , you have to use these CPT codes frequently as they are no more a part of many procedure codes.

References:

http://www.acc.org/latest-in-cardiology/articles/2016/12/07/08/40/cpt-coding-changes-for-moderate-sedation-in-2017

http://www.physicianspractice.com/coding/coding-moderate-sedation-different-2017

https://www.aapc.com/blog/36784-moderate-sedation-bundles-no-more/

https://www.acep.org/Physician-Resources/Practice-Resources/Administration/Financial-Issues-/-Reimbursement/Moderate-(Conscious)-Sedation-FAQ/

http://blog.supercoder.com/coding-updates/rule-change-if-youve-never-reported-moderate-sedation-before-read-this/