Anesthesia Coding Alert

Question: What is the correct way to bill for CPT^® code 99149? Do insurance companies pay for it?

Pennsylvania Subscriber

Answer: Third-party payers may have specific reporting guidelines for 99149 (Moderate sedation services [other than those services described by codes 00100-01999], provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; age 5 years or older, first 30 minutes intra-service time). Contact each of your individual payers for specific reimbursement/payment policy guidelines.

Keep these tips in mind when considering whether to report 99149:

The code refers to the first 30 minutes of intraservice time used to sedate a patient by a physician other than that performing the diagnostic or therapeutic service that the sedation supports. An independent, trained observer must be present to help monitor the patient's level of consciousness and physiological status.

Intraservice time starts with the administration of the sedation agent(s), requires continuous face-to-face attendance and ends at the conclusion of personal contact by the physician providing the sedation.

Code 99149 applies to patients who are 5 years of age or older. If the patient is younger than 5, report 99148 (…younger than 5 years of age, first 30 minutes intra-service time).
If the moderate sedation time goes beyond 30 minutes, also report +99150 (…each additional 15 minutes intra-service time [List separately in addition to code for primary service]).

When reporting moderate sedation codes 99143–99150, make sure your documentation specifies the level of sedation. Documentation requirements may vary by payer, but the minimum would likely be the ASA (American Society of Anesthesiologists) score, the dosage, the length of time, and the documentation of an observer.