# Is it ok to bill 99152 in an office setting?



## chrysel (Feb 1, 2017)

I am receiving denials stating "procedure code inconsistent with POS" and then M77 which is for either invalid or missing modifier. It was billed as POS 11 and TOS 1. Any suggestions on how this needs to be sent. Any help is appreciated.

 Thanks
 Chrysel


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## Chelle-Lynn (Feb 1, 2017)

Time is based on intra-service time, which begins with the administration of sedating agents.
Moderate sedation is administered through an IV to a patient 5 years or older who is undergoing a procedure. The patient is monitored by an observer.
Moderate sedation must be reported separately to receive reimbursement.
_*The service may be reported in a non-facility or facility setting*_


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## chrysel (Feb 1, 2017)

This was for a patient older than 5 years for 15 minutes in an office setting. I'm not sure why this is getting and its more than one claim.


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## tward01 (Feb 2, 2017)

*Moderate sedation denied in office POS 11*

We received the same denial of 99152 and invalid place of service.  I spoke with Medicare this morning and the representative states that 99152 is only valid for inpatient and outpatient out-of-office settings such as ASC, off-campus outpatient facility, etc. and cannot be billed with the POS 11.  My denials are all related to spinal epidural steroid injections (LESI, RFA, etc).  I am unable to find any literature regarding to the places of service allowed for this code.  Can someone direct me to that specific information?  I have received payment from our local BCBS and UHC, just not Medicare. 

Thanks in advance!


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## chrysel (Feb 2, 2017)

I have the exact same problem, denial from Medicare. Commercial payors are paying 99152 just fine. I was unable to find any documentation stating where we can bill and where we cannot. Anyone who knows where I could find this information...please help.
Thanks
Chrysel


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## tward01 (Feb 7, 2017)

I just got notification from Palmetto GBA 99152-99153 are being denied when billed with POS 11.  A system request has been submitted to allow for POS 11.  Once it is actually updated, we can resubmit the claims for payment. 

Sounds to me like the just realized their error and it's being worked on.  Hopefully it won't take months for it to get resolved!


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## Melissa Harris CPC (Feb 15, 2017)

We bill moderate sedation in the office and I have received payment on 99152.  However, 99153 denies with an edit error that will be updated in April 2017.  Make sure your documentation the intraservice time billed.


Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management


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## TammyBennett (Jun 10, 2022)

I too am billing 99156 and 99157 and getting them denied.  I am going to switch to 99152 and 99153 to see if this does pay


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## csperoni (Jun 10, 2022)

TammyBennett said:


> I too am billing 99156 and 99157 and getting them denied.  I am going to switch to 99152 and 99153 to see if this does pay


Read the descriptions of the codes carefully.  If the correct code is 99156, you cannot simply change the code to 99152 if it denies.  
99156 is when you are NOT the clinician performing the procedure.  99152 is when you ARE the clinician performing the procedure.  
As a coder, your responsibility is to use the codes that accurately describe the services performed.  Intentionally using an incorrect code in order to receive payment can run afoul of many regulations and compliance.  You may change a code if it is discovered the original code is incorrect, or per a written carrier policy (like for Medicare inpatient consults, to use 99221-99233).    
If your claim is denied, and codes are correct, the first question would be WHY.  

99156 Moderate sedation services provided by a physician or other qualified health care professional *other than* the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient age 5 years or older   
99152  Moderate sedation services 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; initial 15 minutes of intraservice time, patient age 5 years or older


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