Outpatient Facility Coding Alert
Wake Up to These Moderate Sedation Changes
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Your scope and vascular coding is different this year. Subtle adjustments in coding definitions from year to year can turn into glaring problems if you’re not careful, and that’s the case this year with moderate sedation being removed from more than 300 CPT® codes for procedures. Read on to find out what’s what with your scope and vascular reporting—and whether you’ve coded properly up to now—in the wake of this change. Goodbye, indicator: The change involves removing the “bull’s eye” symbol from the codes, meaning that the codes no longer include conscious (moderate) sedation services. Notice: CPT® 2017 deleted all codes from Appendix G, which previously listed all the codes that included moderate sedation. Instead, a new note directs coders, “For information/guidance on reporting moderate (conscious) sedation services with codes formerly listed in Appendix G, please refer to the guidelines for codes 99151, 99152, 99153, 99155, 99156, 99157.” Understand Endoscopy Transformation Removing conscious sedation from hundreds of codes “will have a big impact on physicians who do scopes frequently,” says Lisa Center, CPC, Physician Practice Manager, Via Christi Hospital Pittsburg, Inc. Pittsburg, KS. There is a great “concern over removal of moderate sedation from endoscopy procedures because of reduction in reimbursement,” echoes Catherine Brink, BS, CMM, CPC, CMSCS, CPOM, president, Healthcare Resource Management, Inc. Spring Lake, NJ. How the change came about: “The landscape for ambulatory endoscopy procedures has changed over the past decade,” says Michael Weinstein, MD, former representative of the AMA’s CPT® Advisory Panel. Physicians have recognized benefits in using Propofol sedation administered by an anesthetist, compared to the benzodiazepine and narcotic combination sedation method administered by the physician-nurse team. “More than half of ambulatory procedures are now performed with Propofol sedation and the change in the coding rules reflects the change in practice.” Under the old code configuration that included moderate sedation in the primary procedure, the anesthetist could submit a claim for sedation administration services, but the surgeon performing the endoscopy could not submit a separate claim for administering sedation. That changes with the CPT® 2017 update. Endoscopy codes that have been revised to remove the conscious sedation symbol include: Look for Vascular Impact, Too In addition to the many endoscopy codes impacted by the removal of moderate sedation services, your surgeons should expect a similar change if they perform vascular procedures. For instance, you’ll see the conscious sedation symbol removed from the following codes in CPT® 2017:
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