Q&A: What is the process for reporting moderate sedation in 2017?

Q: We just finished our annual CPT® review for our chargemaster changes and we noticed that there are new moderate sedation codes for 2017. We also noticed that the appendix listing all the procedures containing moderate sedation is not in the book. The code descriptions are similar, but now we don’t know when we should report the moderate sedation. Moderate sedation has run the gamut from instructions to "report separately" and “don’t report separately,” and we don’t know what to do at this point. However, we do have some payers that require the CPT codes.

A: The reporting of moderate sedation codes has seen a lot of changes over the years. And once again, there was quite a bit of change done for the moderate sedation section of CPT codes for 2017. First, they have “unbundled” moderate sedation from all procedures. Because of this, Appendix G was no longer necessary. In addition, the bull’s eye symbol has been removed from codes, as there is no longer a need to designate the procedures including moderate sedation. As medical technology progresses, procedures are accomplished in a shorter period of time, a different level of anesthesia is indicated for individual patients, etc. In recognition of this, the reporting of moderate sedation has been removed from the procedure codes. In addition, the initial time frame has been changed from “initial 30 minutes” to “initial 15 minutes,” again reflecting the change in the length of time required for procedures.

The CPT Manual provides definitions of “preservice,” “intraservice,” and “postservice” work to differentiate when the moderate sedation codes become reported. In addition, there is a table to assist with the code(s) that should be reported based on the intraservice time. Please be sure to note that if moderate sedation lasts less than 10 minutes, a code is not reported.

CMS is instituting new code G0500 (moderate sedation services provided by the same physician or other qualified healthcare professional performing a gastrointestinal endoscopic service that 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; initial 15 minutes of intraservice time; patient age 5 years or older [additional time may be reported with 99153, as appropriate]) for the initial 15 minutes of moderate sedation when related to a GI endoscopic procedure. This code will be used to report the first 15 minutes of moderate sedation for Medicare patients who undergo an EGD or colonoscopy; after the first 15 minutes, the CPT code for additional time increments will be reported. 

Moderate sedation remains a packaged service under the OPPS; however, as noted in the question, some payers may require the codes to be reported. These services can be reported under revenue code 0370 with or without a HCPCS code. If the time is under 10 minutes (for example), CPT states a code should not be reported; however, you want to ensure that you are reporting the resources/costs involved in the moderate sedation service regardless, in order to guarantee that the appropriate cost information is provided via the claim for future APC ratesetting. 

Editor’s note: Denise Williams, RN, CPC-H, senior vice president of revenue integrity services at Revant Solutions, in Fort Lauderdale, Florida, answered this question.

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