Urology Coding Alert

Pay attention to who does what.

Now that you can report moderate sedation in addition to ureteral stent removal (when justified), it’s important to know how the sedation codes apply. CPT^® 2017 also revised its moderate sedation codes, so the familiar options from days past (99143-99150) are no longer valid.

Which moderate sedation code you report will depend on whether the same provider administers the sedation and performs the service, or whether different providers are involved.

Option 1: When the same physician or other qualified healthcare professional administers moderate sedation and also performs the procedure, choose from:

• 99151 – Moderate sedation services 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; initial 15 minutes of intra-service time, patient younger than 5 years of age
• 99152 – … initial 15 minutes of intra-service time, patient age 5 years or older
• 99153 – … each additional 15 minutes intra-service time (List separately in addition to code for primary service).

Option 2: When one provider performs the procedure and another provider administers moderate sedation, your choices are:

• 99155 – Moderate sedation services provided by a physician or other qualified health care profes­sional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intra-service time, patient younger than 5 years of age
• 99156 – … initial 15 minutes of intra-service time, patient age 5 years or older
• 99157 – … each additional 15 minutes intra-service time (List separately in addition to code for primary service).

Reminder: “In moderate sedation, the patients are purposefully responsive and alert and do not usually require additional intervention such as breathing assistance,” explains coding educator Leslie Johnson, CCS-P, CPC.