Moderate (Conscious) Sedation FAQ

FAQ 1:  Does CPT still use the term Conscious Sedation ?

Starting with the release of the 2006 book CPT has further defined the concept of Conscious Sedation which is now termed Moderate (Conscious) Sedation in an effort to distinguish this service within the spectrum of sedation. Moderate (Conscious) Sedation does not include minimal sedation or anxiolysis, deep sedation or, anesthesia services.

The codes for Conscious Sedation, 99141 and 99142, have been deleted. New codes describing Moderate (Conscious) Sedation have been created within the code series 99143-99150.

 
FAQ 2:  What exactly is Moderate (Conscious) Sedation?

Moderate (Conscious) Sedation [MCS], is a drug induced depression of consciousness. The patient maintains the ability to respond purposely to verbal direction or verbal direction either alone or accompanied by light tactile stimulation. Interventions are not required to maintain the patient’s airway.

 
FAQ 3:  What is included in providing Moderate (Conscious) Sedation?

According to CPT, Moderate (Conscious) Sedation includes:
Assessment of the patient, establishment of IV access, administration of agent(s), maintenance of sedation, monitoring of oxygen saturation, heart rate, and blood pressure, and recovery.

 
FAQ 4:  What CPT codes are used to report MCS when a single provider is overseeing the sedation and performing the MCS supported service?

CPT Code 99143 describes Moderate Sedation provided by the same physician performing the diagnostic or therapeutic service that the sedation supports for patients under 5 years of age for the first 30 minutes of intraservice time.

CPT Code 99144 describes Moderate Sedation provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, for patients over 5 years of age for the first 30 minutes of intraservice time.

CPT Code 99145 describes each additional 15 minutes of intraservice time.

 
FAQ 5:  What CPT codes are used to report MCS provided by one physician in support of a second physician who is performing the diagnostic or therapeutic service?

CPT Code 99148 describes Moderate Sedation provided by a physician, other than the health care professional performing the diagnostic or therapeutic service that the sedation supports, for patients under 5 years of age, for the first 30 minutes of intraservice time.

CPT Code 99149 describes Moderate Sedation provided by a physician, other than the health care professional performing the diagnostic or therapeutic service that the sedation supports, for patients under age 5 years of age, for the first 30 minutes of intraservice time.

CPT Code 99150 describes each additional 15 minutes of intraservice time.

Codes 99143-99145 describe Moderate (Conscious) Sedation services provided by the same physician who is also performing the procedure or diagnostic service for which the Moderate (Conscious) Sedation is needed. Codes 99148-99150 describe Moderate Sedation services provided by a physician other than the health care provider performing the diagnostic or therapeutic service for which the MCS is needed. Both sets of codes are then further delineated based on patient age and incremental time.

 
FAQ 6:  The CPT code descriptor indicates "the first 30 minutes" and "additional 15 minutes", do I have to document how long the patient was sedated?

The intraservice time should be documented in the ED chart.  For these codes, intraservice time is described in the RBRVS Data Manager as:  "The physician supervises the administration and induction of the sedating agent, with or without an analgesic, initiated by the independent, trained observer.  The patient is assessed continuously until an effective, safe level of moderate sedation and/or analgesia is achieved.  Additional doses of sedating and/or analgesic agent(s) are ordered by the physician as needed.  The physican's intraservice time ends when the procedure is complete, the patient is physiologically stable, and face-to-face physician time is no longer required." 

Assessment of the patient and recovery, once personal contact is concluded, are not included in intraservice time. CPT Code 99143 describes Moderate Sedation provided by the same physician performing the diagnostic or therapeutic service that the sedation supports for patients under 5 years of age for the first 30 minutes of intraservice time. 

 
FAQ 7:  Is there a minimum time requirement to report Moderate Sedation?

In October 2011 CPT Assistant indicated that the CPT standard for time measure does apply to the moderate (conscious) sedation codes 99143-99145 and 99148-99150. Per CPT, A unit of time is attained when the midpoint has been passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and sixty minutes). 

Because the Moderate Sedation codes indicate a unit of time of 30 minutes, the ED chart must indicate 16 minutes or more of intraservice time to report Moderate Sedation.  If the time threshold has not been met, then the code is not reportable. 

 

FAQ 8:  Since Moderate Sedation is a time based code, do I need to subtract the time I spend performing other billable procedures i.e., the procedure for which the sedation is being administered?

No.  In 2012, CPT indicated that when using codes 99143-99145, it is understood the physician will be performing a diagnostic/therapeutic procedure at the same time.  There is no need to subtract the procedure time from the Moderate Sedation time.

 
FAQ 9:  How much intraservice time is necessary to report the add-on code that describes one additional unit of 15 minutes of intraservice time?

To meet the CPT requirement of "A unit of time is attained when the midpoint has been passed" a total time of at least 38 minutes of intraservice time must be documented.

 
FAQ 10:  Is Moderate (Conscious) Sedation bundled with or considered an inherent part of any procedures?

CPT indicates conscious sedation is bundled into many procedures. This means the physician performing both these procedures and conscious sedation could not code separately for conscious sedation. This policy has been extended into CPT for Moderate (Conscious) Sedation. Appendix G of CPT 2012 lists 321  procedure codes which include MCS. Codes bundling MCS are denoted with a target symbol in the CPT book. CPT further instructs, in the circumstances when the patient does not require sedation, the operating physician is not required to report the procedure as a reduced service using modifier 52.

Codes of interest to emergency medicine bundling Moderate (Conscious) Sedation include the following:

31615 tracheobronchoscopy through tracheostomy
31622 bronchoscopy diagnostic
32551 chest tube insertion
33010 pericardiocentesis
33210 insertion transvenous pacemaker
36555 insertion pediatric (under age 5) central line
36568 insertion pediatric (under age 5) PICC line
92953 transcutaneous pacing
92960 elective cardioversion 

Do not report codes 99143-99145 with procedures listed in Appendix G.

 
FAQ 11:  Will MCS be bundled with procedures listed in Appendix G in the scenario where the MCS is being provided by the ED physician in support of a second physician who is performing the diagnostic and therapeutic service?

When the Moderate (Conscious) Sedation services are provided in the Emergency Department setting, by a second physician in support of a procedure listed in Appendix G, the moderate sedation service codes 99148-99150 may be reported.

 
FAQ 12:  Are there any other special requirements for coding Moderate (Conscious) Sedation?

The MCS services described by codes 99143-99145 require the presence of an independent trained observer to assist in the monitoring of the of the patient’s level of consciousness and physiologic status.

 
FAQ 13:  Does Medicare have any specific regulations in respect of Moderate (Conscious) Sedation?

National Medicare has reconsidered its payment policy on Moderate (Conscious) Sedation. For 2009, the codes have been assigned a Status Indicator C, meaning they are carrier priced, and do not carry an assigned RVU. Regional Medicare carriers are being encouraged by National CMS to recognize Moderate Sedation services.

For more detail, see CMS Transmittal 1324.

 

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