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ED Coding and Reimbursement Alert

Reader Question:

Use Correct Time Threshold For Moderate Sedation

Published on Wed Nov 24, 2010

Question: In our ED group, our moderate sedations are usually less than 16 minutes. The CPT Assistant® Oct 2011 issue states that if the moderate sedation is less than 16 minutes, it is not separately billable. Is that correct?Wisconsin SubscriberAnswer: The October 2011 CPT Assistant® reference comes from a Commonly Asked Questions Section asking if it is appropriate to report the moderate sedation codes for the first 30 minutes of Intraservice time if only 10 minutes of moderate sedation are provided. The answer given was no.The rationale offered was that moderate sedation codes are time based and the CPT® descriptors for the base codes (99143, 99144, 99148 and 99149) specifically mention 30 minutes of intra-service time. Intra-service time is defined in the moderate sedation preamble to begin with the administration of the sedation agent, requiring continuous face to face attendance, and ending when that personal contact concludes. If the period [...]
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