Outpatient Facility Coding Alert
Don't Go by Appendix B of AMA's CPT® 2017 For Moderate Sedation
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Question: Going by AMA’s CPT® 2017 Appendix B, “Summary of Additions, Deletions, and Revisions,” one should not report moderate sedation separately when a provider performs both the sedation and a procedure marked with a symbol. Does that mean all the codes marked with that symbol in the appendix still include moderate sedation, despite the removal of moderate sedation from so many codes in 2017? Codify Subscriber Answer: The Appendix B wording here was a publishing error. You may refer to AMA’s Errata and Technical Corrections document that clarifies that CPT® 2017 does delete the moderate sedation symbol. You can find the errata document at www.ama-assn.org/practice-management/errata-technical-corrections. Background: CPT® 2017 eliminates the moderate sedation symbol. One result of the change is that you must report moderate sedation codes to receive CPT® code reimbursement for that service. This change affects many gastroenterology, vascular and EP services that included moderate sedation as inherent to the procedure in previous years (meaning the procedure included reimbursement for moderate sedation so you could not report the sedation separately). In 2017, you must report a code for moderate sedation to receive payment for that service. The surgical procedures will no longer factor in reimbursement for the sedation. Also note that the previous codes were eliminated and new codes were added for moderate sedation in 2017.
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