Thursday, September 15, 2016

CPT CODE 99143, 99144 AND 99145

CPT CODE and Description

99143 - Moderate sedation services (other than those services described by codes 00100-01999) 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; younger than 5 years of age, first 30 minutes intra-service time

99144 - Moderate sedation services (other than those services described by codes 00100-01999) 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; age 5 years or older, first 30 minutes intra-service time

99145 - Moderate sedation services (other than those services described by codes 00100-01999) 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; each additional 15 minutes intra-service time

Deleted Procedure Codes

Services are denied each year because of outdated CPT manuals Located in Appendix B 99143, 99144 and 99145  Deleted codes are identified in the CPT manual by parenthetical notes

A notation may include a code or codes to use in its place(For example, 99143, 99144 and 99145 have been deleted. To report, see 99151, 99152, 99153)

http://www.anesthesiabilling.org/2017/04/monitored-anesthesia-cpt-code-list.html


Policy: The anesthesia payment policy in Pub. 100-04, chapter 12, section 50 is being revised so that it is consistent with the pricing of the conscious sedation codes under the Medicare physician fee schedule and CPT coding guidelines. The new policy is as follows:

If the physician performing the procedure also provides moderate sedation for the procedure, then payment may be made for conscious sedation consistent with CPT guidelines. If the physician performing the procedure also provides local or minimal sedation for the procedure, then no separate payment is made for the local or minimal sedation service. The carrier shall follow the NCCI edits imposed for codes 99143 and 99144 if billed with any procedure in Appendix G of the CPT.


The CPT includes Appendix G, Summary of CPT Codes That Include Moderate (Conscious) Sedation. This appendix lists those procedures for which moderate (conscious) sedation is an inherent part of the procedure itself. CPT coding guidelines instruct practices not to report CPT codes 99143 to 99145 in conjunction with codes listed in Appendix G. The National Correct Coding Initiative has established edits that bundle CPT codes 99143 and 99144 into the procedures listed in Appendix
G.

Three of these codes (99143, 99144, and 99145) describe the scenario in which the same physician performing the diagnostic or therapeutic procedure provides the moderate sedation, and an independent trained observer’s presence is required to assist in the monitoring of the patient’s level of consciousness and physiological status. The other three codes (99148, 99149, and 99150) describe the scenario in which the moderate sedation is provided by a physician other than the one performing the diagnostic or therapeutic procedure.



CR 5618 presents some specific points that you should be aware of:

• CPT coding guidelines for conscious sedation codes instruct practices not to report Codes 99143 to 99145 in conjunction with the codes listed in CPT Appendix G. Your carrier or A/B MAC will follow the National Correct Coding Initiative, which added edits in April 2006 that bundled CPT codes 99143 and 99144 into the procedures listed in Appendix G (There are no edits for code 99145; it is an add-on-code and it is not paid if the primary code is not paid.).


BCBS Guidelines

Coverage of IV moderate sedation is appropriate for patients undergoing surgical or endoscopic procedures when general, local, or regional anesthesia is not the more appropriate choice. These decisions are based on the patient's medical  condition, age, and the type of procedure.

Reimbursement for moderate sedation is built into the compensation valuation for many  procedures. The oversight of the physician is inherent in the procedure allowance and the staff time is inherent in the facility allowance. Therefore, moderate sedation by the physician performing the procedure is not separately reimbursed (CPT codes 99143, 99144, 99145).


Coding:

99144 (NOT SEPARATELY REIMBURSED)


• The sedation service must be medically necessary for the management of the patient. Preliminary data analysis of claims submitted for these services indicates that CPT codes 99144–99145 are being billed with routine injection services and other minor procedures for which moderate sedation may not be “reasonable.” Title XVIII of the Social Security Act, Section 1862(a)(1)(A), states “... No payment may be made under Part A or Part B for any expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.”

• Report only the time of face-to-face physician contact, starting with the time when the physician starts the anesthesia to the time the physician breaks face-to-face contact. The reported time stops when the physician breaks face-to-face contact, even if the trained observer stays for a longer period of time to monitor recovery. The additional time the trained observer stays to monitor recovery after the physician leaves the patient’s bedside is not a service separately billable to Medicare. The Medicare “incident to” provisions do not apply to this service since the service is defined in terms of face-to-face physician time.

• These codes may not be used to report a level of anesthesia lower in intensity than moderate or conscious sedation such as local or topical anesthesia or minimal sedation.

• For this service, Medicare defines a “physician” as an MD, DO or other physicians and non-physician practitioners licensed by the state to perform conscious sedation in addition to the diagnostic or therapeutic service for which sedation is required.


moderate/Conscious Sedation - Time Examples 

Below are some examples of moderate/conscious sedation time. ** 1 - 15 minutes of intraservice time = No CPT code assigned as the mid-point has not been reached;

service included in the E/M level.

** 16 - 37 minutes of intraservice time = Code for 1st 30 minutes

** 38 - 52 minutes = Code for 1st 30 minutes + 1 unit of the each additional 15 minutes code (i.e., 99144, 99145)

** 53 - 67 minutes = Code for 1st 30 minutes + 2 units of the each additional 15 minutes code (i.e., 99144, 99145, 99145)

** 1 hr, 20 minutes - Codes for 1st 30 minutes + 3 units of the each additional 15 minutes code (i.e., 99144, 99145, 99145, 99145)

In closing, Moderate Sedation Services are frequently provided in the Emergency Department setting. Emergency Department Physicians should familiarize themselves with the time measurement changes to the Moderate Sedation codes as these changes directly affect coding and billing. It is required that the physician document the length of intra-service time providing Moderate Sedation Services. Without a time statement these services are not billable because the coder cannot assume that the minimum time threshold of 16 minutes has been met.

Medicare payment Guide

In 2006, the CPT added new codes for moderate (conscious sedation). These are CPT codes 99143 to 99150.

Moderate sedation is a drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Moderate sedation does not include minimal sedation, deep sedation or monitored anesthesia care.

Codes 99143 to 99145 describe moderate sedation provided by the same physician 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. The physician can bill the conscious sedation code as long as the procedure with which it is billed is not listed in Appendix G of CPT.

Codes 99148 to 99150 describe moderate sedation provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports.

Appendix G, Summary of CPT Codes That Include Moderate (Conscious) Sedation, lists those procedures for which conscious sedation is an inherent part of the procedure itself. CPT describes the interrelationship between the appendix and the conscious sedation codes.

CPT coding guidelines instruct practices not to report Codes 99143 to 99145 in conjunction with codes listed in Appendix G. The National Correct Coding Initiative added edits in April 2006 that bundled CPT codes 99143 and 99144 into the procedures listed in Appendix G. (There are no edits for code 99145; it is an add-on-code and it is not paid if the primary code is not paid.)

In the unusual event when a second physician other than the health care professional performing the diagnostic or therapeutic services provides moderation sedation in the facility setting for the procedures listed in Appendix  G, the second physician can bill 99148 to 99150. However, when these services are performed by the second physician in the nonfacility setting, codes 99148 to 99150 are not to be reported.

Anesthesia Services Furnished by the Same Physician

Providing the Medical and Surgical Service

Physicians who both perform and provide moderate sedation for medical/surgical services will be paid for the conscious sedation consistent with CPT guidelines. However, physicians who perform and provide local or minimal sedation for these procedures will not be paid separately for the sedation services.

Providers should ensure their billing staffs are aware of these payment policies that address the same physician performing both the medical/surgical service and the conscious sedation service.

The continuum of complexity in anesthesia services (from least intense to most intense) ranges from:

• Local or topical anesthesia

• Moderate (conscious) sedation

• Regional anesthesia

• General anesthesia



Moderate sedation is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. It does not include minimal sedation, deep sedation or monitored anesthesia care.

If the physician performing the procedure also provides moderate sedation for the procedure, payment may be made for conscious sedation consistent with CPT guidelines; however, if the physician performing the procedure provides local or minimal sedation for the procedure, no separate payment is made for the local or minimal sedation service.

Payment will not be allowed for CPT codes 99148–99150 if any of these codes are performed on the same day with a medical/surgical service listed in Appendix G of the CPT book and the service is provided in a non-facility setting. A facility is defined as one with a place of service code of 21, 22, 23, 24, 26, 31, 34, 41, 42, 51, 52, 53, 56 or 61.

Prior to 2006, Medicare did not recognize separate payment if the same physician both performed the medical or surgical procedure and provided the anesthesia needed for the procedure. The final physician fee schedule published in the Federal Register November 21, 2005, included newly created CPT codes (99143–99150) for moderate (conscious) sedation, which was added to CPT in 2006.

Note: These codes have been assigned a status indicator of “C” under the Medicare physician fee schedule designating that these services are carrier-priced. CMS has not established relative value units for these services.

Three of these CPT codes (99143, 99144 and 99145) describe a scenario in which the same physician performing the diagnostic or therapeutic procedure provides the moderate sedation, and an independent trained observer’s presence is required to assist in monitoring the patient’s level of consciousness and physiological status. The other three CPT codes (99148, 99149 and 99150) describe moderate sedation is provided by a physician other than the one performing the diagnostic or therapeutic procedure.


Question:

One of our physicians adds 99144 to his billing sheet whenever he performs LESI, CESI, and other nerve block injections. None of the other physicians I code for have ever added the moderate sedation code to these injections. Is this something that is normally done?

Answer:
Some providers do use moderate sedation when performing these pain management procedures, although others do not. If so, reporting 99144 (Moderate sedation services [other than those services described by codes 00100-01999] 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; age 5 years or older, first 30 minutes intra-service time) is appropriate if you have supporting documentation.

Anesthesia Services Furnished by the Same Physician Providing the Medical or Surgical Service

GENERAL INFORMATION

This section instructed the carriers not to allow separate payment for the anesthesia service performed by the physician who also furnishes the medical or surgical services. It pointed out, for example, that the carriers may not allow separate payment for the surgeon’s performance of a local or surgical anesthesia if the surgeon also performs the surgical procedure. Similarly, separate payment is not allowed for the psychiatrist’s performance of the anesthesia service associated with the electroconvulsive therapy if the psychiatrist performs the electroconvulsive therapy.

In 2006, the CPT added new codes for moderate (conscious sedation). These are CPT codes 99143 to 99150. Moderate sedation is a drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Moderate sedation does not include minimal sedation, deep sedation or monitored anesthesia care.

Codes 99143 to 99145 describe moderate sedation provided by the same physician 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. The physician can bill the conscious sedation code as long as the procedure with which it is billed is not listed in Appendix G of CPT.

Codes 99148 to 99150 describe moderate sedation provided by a physician other than the health careprofessional performing the diagnostic or therapeutic service that the sedation supports. Appendix G, Summary of CPT Codes That Include Moderate (Conscious) Sedation, lists those procedures for which conscious sedation is an inherent part of the procedure itself. CPT describes the interrelationship between the appendix and the conscious sedation codes.

CPT coding guidelines instruct practices not to report Codes 99143 to 99145 in conjunction with codes listed in Appendix G. The National Correct Coding Initiative added edits in April 2006 that bundled CPT codes 99143 and 99144 into the procedures listed in Appendix G. (There are no edits for code 99145; it is an add-on-code and it is not paid if the primary code is not paid.)

In the unusual event when a second physician other than the health care professional performing the diagnostic or therapeutic services provides moderation sedation in the facility setting for the procedures listed in Appendix

G, the second physician can bill 99148 to 99150. However, when these services are performed by the second physician in the nonfacility setting, codes 99148 to 99150 are not to be reported. Since 2006, the conscious sedation codes have been assigned a status indicator of “C” under the physician fee schedule designating that these services are carrier priced. CMS has not established relative value units for these services.

B. Policy: The anesthesia payment policy in Pub. 100-04, chapter 12, section 50 is being revised so that it is consistent with the pricing of the conscious sedation codes under the Medicare physician fee schedule and CPT coding guidelines. The new policy is as follows:

If the physician performing the procedure also provides moderate sedation for the procedure, then payment may be made for conscious sedation consistent with CPT guidelines.

If the physician performing the procedure also provides local or minimal sedation for the procedure, then no separate payment is made for the local or minimal sedation service.

The carrier shall follow the NCCI edits imposed for codes 99143 and 99144 if billed with any procedure in Appendix G of the CPT.

REIMBURSEMENT INFORMATION:

Attending Physician (99143-99145)

Codes 99143 to 99145 describe moderate sedation provided by the same physician 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.

Appendix G of the CPT codebook, Summary of CPT Codes That Include Moderate (Conscious) Sedation, lists those procedures for which conscious sedation is an inherent part of the procedure itself. CPT describes the interrelationship between the appendix and the conscious sedation codes.

Florida Blue/Health Options will separately allow codes 99143 to 99145 as long as the procedure with which it is billed is not listed in Appendix G of CPT.

Florida Blue/Health Options follows the National Correct Coding Initiative (NCCI) edits imposed for codes 99143 to 99145 if billed with any procedure in Appendix G of the CPT; therefore, codes 99143 to 99145 will not be separately reimbursed when billed with radiation therapy services.

Furthermore, codes 99143 to 99145 will not be separately reimbursed with any procedure whose
description contains “with anesthesia”, “under anesthesia”, “under or requiring general anesthesia”, etc. based on their verbiage and the fact that conscious sedation is not expected with these procedures.

99143 Moderate sedation service (other than those services described by codes 00100-01999) provided by the same physician 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; under 5 years of age, first 30 minutes intraservice time

Limitations Based on the CPT Code Definitions 99143–99145

• An independent trained observer whose sole duty is to monitor the patient’s level of consciousness and physiological status must be present throughout the diagnostic or therapeutic service. The anesthesia note must identify this person and his credentials (e.g., RN, NPP, PA).

• “Intra-service 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.” (Per CPT)

• Do not report CPT codes 99143–99145 with codes listed in Appendix G of the CPT book. (These codes include payment for moderate sedation.)

When billing CPT codes 99143–99145, the physician performing the diagnostic or therapeutic service must also bill for the anesthesia service on the same claim and must be licensed to perform both the diagnostic or therapeutic service and the anesthesia service.

• Documentation must include a separate anesthesia note with a patient assessment, the method and route of administration of conscious sedation, start and stop times, baseline vital signs, vital signs every 5 to 15 minutes (depending on patient status), identity of trained observer (for CPT codes 99143–99145), method of monitoring heart rate, oxygen saturation (if any) and recovery time.

• The provider must make the anesthesia note and the justification from the medical record of the medical necessity of the service available upon request.



Anesthesia Claims

When filing claims for anesthesia services (anesthesia codes 00100-01999), minutes—rather than units—must be billed.

- Anesthesia Time Units are reported in one minute increments and noted in the unit’s field.

- When multiple surgical procedures are done, only report the anesthesia code with the highest base value with the TOTAL time for all procedures. Multiple anesthesia codes will not be reimbursed. Effective on November 14, 2009 with ClaimsXten implementation, if multiple anesthesia codes are billed on the same date of service the line with the lowest charge will be denied.

- Obstetrical epidural anesthesia edits may occur when the reported anesthesia time exceeds 2.5 hours if the provider does not have a global contract. A maximum of 2.5 hours of anesthesia time is routinely allowed. Upon review,additional time units may be allowed with documentation that face-to-face time with the obstetrical patient exceeded 2.5 hours.

- When billing surgery codes, only bill one unit of service as time is not considered. Surgical codes are reimbursed based on the RVU for the surgical procedure times the surgical conversion factor.

- Procedure codes published in CPT Appendix G include moderate sedation (99143 and 99144) as global to performing the procedure and are not eligible for separate reimbursement.

- Moderate sedation rendered by a provider who is not performing the diagnostic or therapeutic procedure is not eligible for reimbursement in a non-facility setting such as a provider’s office or a clinic.

- Modifier AA should be reported in the last modifier position when other payment modifiers such as P3 are billed in order to assure additional allowance is added for the payment modifiers. (Modifier AA is not necessary as it is assumed unless there is a “Q” modifier to indicate otherwise.)

- If more than one payment modifier is billed, then modifier 99 should be billed in the first position to ensure all payment modifiers are applied. (Example: 99, QX, P3)

- For more information on Anesthesia services please see Reimbursement Policy Anesthesia.

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