Rule Change: If You’ve Never Reported Moderate Sedation Before, Read This

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Rule Change If Youve Never Reported Moderate
Sedation Before, Read This
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Its time to start adjusting your brain to the
new reality about moderate sedation coding. For
years, youve trained yourself to not report your
providers moderate sedation separately when CPT
marked the procedure code with a circle with a
center dot symbol and listed the code in Appendix
G. But the 2017 Medicare Physician Fee
Schedule and CPT 2017 want to change all that.
CPT 2017 removes the symbol from more than 400
codes, and that means you need to report the
moderate sedation code if you want to be paid for
it. Codes for vascular procedures,
electrophysiology, and gastroenterology
procedures dominate the list of codes that
carried the moderate sedation symbol in 2016 and
before, so if you code for those services, you
need to pay particular attention to the changes
coming for moderate sedation.
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Focus on Age and Time to Find Right Codes
In addition to changing the rules for reporting
moderate sedation, CPT changes the codes, too.
CPT 2017 deletes current moderate sedation codes
99143-99150. The replacement codes are similar
to the old codes (with some variations in time
requirements), but if you never used the old
codes, that news doesnt help you much. Youll
choose from these 2017 codes when a physician or
other health care professional provides the
moderate sedation for a procedure shes
performing herself (bold added)

• 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
  patients 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).

Key points Code 99151 applies to the first 15
minutes of moderate sedation services for a
patient younger than five. If the patient is five
or older, use 99152 for the first 15 minutes.
Code 99153 applies to each additional 15 minutes
regardless of patient age. Worth
noting Additional new codes 99155, 99156, and
99157 look a lot like 99151-99153 but apply
when someone other than the surgical provider
performs the moderate sedation services.
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Heres Proof Reviewing the Proposed MPFS Is
Helpful
The proposed 2017 Medicare Physician Fee
Schedule provides insights into why the change is
happening. The short version is that Medicare
factored payment for moderate sedation into
procedure codes with the moderate sedation
symbol. Medicare has noticed anesthesia getting
reported separately for scope procedures with the
moderate sedation symbol and didnt want to pay
for both the anesthesia performed and the
moderate sedation not performed. After
considering different options, like removing the
symbol from only certain codes, the decision was
to streamline and have providers report and get
paid for moderate sedation only when they perform
it. What does this mean to you? If you report
any services listed in AMAs CPT 2016 Appendix
G, youve got some work to do. You need to review
the new codes, read the guidelines, and ensure
that your documentation clearly documents
everything you need to support reporting the new
codes. The plan is to reduce RVUs for those
Appendix G codes because moderate sedation will
no longer be included, so reporting moderate
sedation when appropriate is crucial to your goal
of bringing in every dollar you deserve.
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Gastro coders beware Keep an eye on HCPCS 2017.
You can expect to use a new G code for Medicare
claims instead of 99152 to better reflect the
work involved Moderate sedation services
provided by the same physician or other qualified
health care professional performing a
gastrointestinal endoscopic service (excluding
biliary procedures) that sedation supports,
requiring the presence of an independent trained
observer to assist in the monitoring of the
patients level of consciousness and
physiological status initial 15 minutes of
intra-service time patient age 5 years or
older. Watch private payer policies to see if
they accept the new G code, too.
How About You? Are you ready to start reporting
moderate sedation? Are you concerned about the
RVUs changes?
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