Urology Coding Alert

Question: The urologists in my office occasionally perform procedures in the office after putting the patient under moderate sedation. I'm never sure whether to report 99143-99145 or 99148-99150. Would you explain the difference?


Colorado Subscriber

Answer: You can easily determine the correct code set if you answer this question: Does the sedation and procedure involve one physician or two?

• One MD: When a urologist performs the procedure and provides the sedation, you should use 99143-99145 (Moderate sedation services ... provided by the same physician performing the diagnostic or therapeutic service that the sedation supports ...).

• Two MDs: When different physicians provide the procedure and sedation, use the second set of codes, 99148-99150 (Moderate sedation services ... provided by a physician other than the healthcare professional performing the diagnostic or therapeutic service that the sedation supports ...).

Remember: Codes 99143-99144 and 99148-99149 capture the first 30 minutes of intra-service time. For each additional 15 minutes, assign 99145 or 99150.

Check with your carrier: You may be tempted to neglect reporting the sedation to the insurer because many carriers still don't reimburse for the moderate sedation. Leaving these codes off the claim could be a mistake, however, because some insurers have started paying for this service.

Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist, two-urogynecologist practice in Indianapolis.