Important CPT Code Changes for 2017 and How They Will Impact Documentation – Moderate (Conscious) Sedation Code Changes

Moderate (Conscious) Sedation Code Changes

As you know, medical coding data sets, including Current Procedural Terminology (CPT) and  Healthcare Common Procedure Coding System (HCPCS), have comprehensive annual updates. For 2017, the American Medical Association  and CMS released over 1,200 code changes including new, revised, and deleted codes. We will review some of the key moderate sedation code changes that may impact your documentation for 2017. Please note that this list is not all-inclusive. We strongly encourage you to review all revisions, deletions, and additions.

The moderate sedation symbol (®) has been removed from more than 400 codes that carried the mark meaning that the procedure code for these services will no longer include moderate sedation services. Additionally, Medicare has assigned RVU values nationally for the new codes.

Moderate sedation codes were also deleted, and the new codes will be applied in 15-minute increments instead of the 30 minutes used in 2016. The “intraservice” time for sedation must be documented in order to accurately code. Intraservice time starts with the administration of the sedation agent(s), requires continuous face-to-face attendance, and ends at the conclusion of personal contact by the physician providing the sedation.

CMS has assigned National RVU values to moderate sedation codes which means these services are no longer priced by each individual Medicare Administrative Contractor (MAC). Properly document and code for these service to ensure reimbursement.

Medicare also has a specific HCPCS code for GI endoscopic services which has an independent definition for intraservice time. If you perform these services, please take a few minutes to become familiar with those rules.

99151Moderate sedation services provided by the same physician or other qualified healthcare 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
99152initial 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)
99155Moderate sedation services provided by the same physician or other qualified healthcare professional other than the physician or other qualified healthcare professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age
99156initial 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)
G0500Moderate sedation services provided by the same physician or other qualified healthcare 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 intraservice time; patient age 5 years or older (additional time may be reported with 99153, as appropriate)

  • Codes 99151- 99157 are not used to report administration of medications for pain control, minimal sedation, deep sedation, or monitored anesthesia care (00100-01999.)
  • 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.
  • Codes 99151- 99157 include pre, intra, and post-service work associated with sedation services.

Current Procedural Terminology (CPT) is copyright 2017 American Medical Association. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no other health insurance liability for the data contained herein.