Radiology Coding Alert

Question: Our physician used moderate sedation for a radiological examination in an emergency setting. Is it possible that we bill for moderate sedation that lasts less than 16 minutes in duration?

Wisconsin Subscriber

Answer: Moderate sedation of less than 30 minutes is common in ED settings. Depending upon the intra-service time for moderate sedation, you can select from the following codes for moderate sedation:

• 99143, Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; younger than 5 years of age, first 30 minutes intra-service time 
• 99144, … age 5 years or older, first 30 minutes intra-service time
• +99145, … each additional 15 minutes intra-service time (List separately in addition to code for primary service)
• 99148, Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; younger than 5 years of age, first 30 minutes intra-service time
• 99149, … age 5 years or older, first 30 minutes intra-service time
• +99150, … each additional 15 minutes intra-service time (List separately in addition to code for primary service)

If the period of moderate sedation intra-service time extends past 30 minutes, you report the add-on codes, +99145 and +99150.

What is intra-service time? You count intra-service time as defined in the moderate sedation code descriptions when your physician begins the administration of the sedation agent. Remember, this encounter requires continuous face to face attendance and ends when this personal meeting concludes. 

Although pre- and post-service times associated with moderate sedation are included in assignment of its value, for reporting purposes, you count only the intra-service time. 

The CPT® Assistant further specifies the following;

“A unit of time is attained when the midpoint is passed. Therefore, in order to report a code with a unit time of 30 minutes, 16 minutes or more of the service described must be provided.”