# Moderate sedation denials 99152



## rreyes1423

Everything I have read this year regarding the new moderate sedation codes are that for the initial 15 mins 99152 is to be coded and for every additional 15 mins bill 99153. I have received countless denials for 99152 but they are paying 99153. I called the insurance company and they are saying that 99152 is no longer valid code per CPT/HCPCS manual. Is anyone else running into this issue? We are a vascular practice so you can imagine with all the percutaneous procedures that are done and each time moderate sedation is used and billed are now being denied.  Thanks you in advance!


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## Ginger417

We are having the opposite problem. We are getting paid for 99152 but all of our 99153s are being denied for CO-109. I don't think the payors know what they are doing with these codes yet.


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## AWilliams@mobheart.com

Can someone verify if the provider must document sedation time for 99152?


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## Bombinat

This is the requirement for Medicare for GI procedures.  For commercial plans use 99152 and same documentation requirements. 

If the patient has Medicare or a Medicare Advantage plan: 
The initial 15 minutes of anesthesia is reported as G0500.  The operative note must document: 
-	Time from start of anesthesia to end of anesthesia.  Doctor does not need to give the clock start and stop time.  They do need to state in the operative note the total anesthesia time.  If the doctor documents 10-22 minutes, use G0500. If the doctor documents 22 or more minutes, use G0500 and 99153.
-	That there was an independent observer to assist in monitoring.


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## tmedina99

*MOderate sedation documentation*

Just to clarify- as long as the physician mentions that the procedure was performed under moderate sedation and patient monitored by RN... that should be enough to code the appropriate moderate sedation codes? RN is administering the sedation drug and documenting the face to face time with the patient.


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## adamsc

I work for a Vascular Practice as well if you are billing Codes 36901 – 36909. The 2017 NCCI Edits are wrong. We found this in regards to it:
These errors will be corrected in the 4/1/2017 NCCI updates. 
NCCI recommends providers delaying submission of claims for CPT codes 99151-99153 when performed with one of the listed surgical or Category III codes until the new versions of NCCI PTP edits are implemented 4/1/2017. Claims submitted prior to the correction in April 2017 will be denied. The denial may be appealed on or after 4/1/2017.


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## prallapalli

*99153*



tmedina99 said:


> Just to clarify- as long as the physician mentions that the procedure was performed under moderate sedation and patient monitored by RN... that should be enough to code the appropriate moderate sedation codes? RN is administering the sedation drug and documenting the face to face time with the patient.



Novitas has this code payment issue listed in Claim Issues-Part-B .  Please read the decision made as of 03/03/17 and 04/03/17 for inpatient and outpatient claims billed by professional provider:
https://www.novitas-solutions.com/w...-state=ncoenn52y_4&_afrLoop=1169584079414384#!


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## jasonrme

We have several claims not paid by Medicare and directing us to bill the Skilled Nursing Facility for the Moderation sedation. I find this odd as Medicare paid for the rest of the procedure. Anyone else running into the same issue?


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## thrower4899

*99152*

May we use Lidocaine 1cc of 1% to consider as Moderate sedation


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## tanyaneeley

*Moderate Sedation Denials*

I have several claims in which commercial payers are denying 99152 as exclusive to 45378 (Colonoscopy)...   Can 99152 be billed with endocopy procedures?? Please help.


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## mitchellde

thrower4899 said:


> May we use Lidocaine 1cc of 1% to consider as Moderate sedation


Lidocaine is a local anesthetic and may not be billed as moderate sedation.


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