Effective Jan. 1, 2017, reimbursement for moderate (conscious) sedation (MS) is no longer bundled in with procedures and may be reported separately. There are six new MS codes to report as shown below.
| Age of Patient | MS provided by same physician as performing the procedure | Physician performing MS only |
| Total intra-service time for patient under 5 years old | 99151 (initial 15 minutes), 99153 (each additional 15 minutes) | 99155 (initial 15 minutes); 99157 (each additional 15 minutes) |
| Total intra-service time for patient under 5 years or older | 99152 (initial 15 minutes), 99153 (each additional 15 minutes) | 99156 (initial 15 minutes); 99157 (each additional 15 minutes) |
Some important coding tips to remember:
If the time of MS is less than 10 minutes, MS may not be reported.
- For facility settings (including inpatient and provider-based), you may report +99157 (each additional 15 minutes) when you are performing MS only.
- For office settings, you may report the additional time code +99153 (each additional 15 minutes) when you are performing both the procedure and MS.
The MS codes are time-based codes and require documentation of the time spent during the intra-service work (commonly referred to as “skin-to-skin” time) in order to bill. Pre-service and post-service work time cannot be included. Intra-service work:
- Begins with the administration of the sedating agent(s);
- Ends when the procedure is completed, the patient is stable for recovery status, and the physician providing the sedation ends personal continuous face-to-face time with the patient;
- Includes ordering and/or administering the initial and subsequent doses of sedating agents;
- Requires continuous face-to-face attendance of the physician;
- Requires monitoring patient response to the sedating agents, including:
- Periodic assessment of the patient;
- Further administration of agent(s) as needed to maintain sedation; and
- Monitoring of oxygen saturation, heart rate, and blood pressure.
If you are providing and billing MS with a resident/fellow, your teaching physician (TP) documentation must support the following:
- your presence during all critical or key portions of the MS service; and
- your immediate availability to provide MS services during the entire procedure.
Example: I was present and immediately available for key and critical components of the 35- minute moderate sedation service.
Nurse sedating patient
For documentation questions, please contact Terry Turcio, compliance manager, at theresa.turcio@yale.edu. Questions regarding reimbursement should be directed to the Revenue Integrity Analytics (RIA) Department.
STUDENTS
Services rendered by students are not considered billable services. “Students” include but are not limited to medical students, advanced practice practitioner students, and audiology students.
Any participation or contribution of a student to the performance of a billable service must be performed in the physical presence of a teaching physician or in the physical presence of a resident in a service that meets the requirements for teaching physician billing. This does not include review of systems (ROS) and/or past family/social history, which is not separately billable but taken as part of an E&M service.
Students may document services in the medical record. However, the documentation of an E&M service by a student that may be referred to by the teaching physician is limited to documentation related to the ROS and/or past family/social history. The teaching physician may not refer to a student’s documentation of physical exam findings or medical decision-making in their personal note.
If the medical student documents E&M services, the teaching physician must verify and re-document the history of present illness as well as perform and re-document the physical exam and medical decision-making activities of the service.