Conscious sedation codes are based on time intervals and patient age.
How has coding for moderate sedation and conscious sedation changed?
Answer: Moderate sedation has always been an area of frustration for coders and physicians because it was considered included in CPT coding and not separately reportable. There is good news, as this symbol has been removed from more than 400 codes, effective Jan. 1, 2017.
The old series of codes within 99143-99150 have been deleted. However, there are many requirements for the new moderate sedation CPT codes, in the series of 99151-99157.
- The new codes are timed codes, and change and start at increments of 15 minutes, instead of the previous 30-minute requirement.
- There is an add-on code for incremental 15-minute time components.
- Code sequences vary based on whether the patient is younger than five years of age.
Service requirements and documentation requirements to support moderate sedation services, must comply with the activities that are required, including pre-sedation, intraservice, and post-sedation elements.
It also should be noted that while the initial code is based on 15-minute increments, the code can be reported, as long as a minimum of 10 minutes is spent for the initial service. Education of providers and coders alike needs to be performed to appropriately capture the new service codes and ensure that all the required elements are supported.
Also, please note, if you bill CMS and have providers doing endoscopies with conscious sedation, they created a G code specifically for those services. G0500 is specifically for moderate sedation, initial 15 minutes of intra-service time, for a qualified healthcare professional performing a gastrointestinal endoscopic service. If the time component exceeds the initial 15 minutes, the add-on code of 99153 also should be reported with the G code.