Cardiology Question for the Week of February 20, 2017

Question:

Question:

Do the changes to the moderate sedation guidelines mean that my doctor can now bill for this when he provides it during a transesophageal echocardiogram (TEE)?

Answer:

Answer:

Yes. Moderate (conscious) sedation (MS) is no longer bundled into procedures. All of the procedures that have previously included moderate sedation have been deleted from Addendum G in the CPT book.

If your doctor provides MS while performing a TEE, he may separately report it. Code 99151 (under 5 years) or 99152 (5 years or older) are reported for the first 15 minutes of MS when provided by the same provider performing the base procedure. Code 99153 is reported for each additional 15 minutes of MS. These three codes require the presence of an independent trained observer to monitor the patient’s level of consciousness and physiological status during the procedure. This observer must not have other duties at the same time.

Only continuous face-to-face intra-service time by the physician may be counted for coding of moderate sedation. Pre-service and post-service time work of the physician is included in the payment, but the time is not counted when choosing the codes. Intraservice time begins with the administration of the sedating agent(s) and ends when the procedure is completed, the patient is stable for recovery status, and the physician ends personal continuous face-to-face time with the patient.

At least 10 minutes of MS time must occur before the initial code (99151 or 99152) may be reported. If less than 10 minutes of MS is performed, it is not separately billed. Before the additional 15 minutes code (99153) is reported, more than one-half of the additional 15 minutes must pass. For instance, to bill 99152 and 99153, the physician should provide the full initial 15 minutes plus at least eight additional minutes of sedation. The CPT book has a time chart to help determine codes billed for longer terms of moderate sedation.