Wiki Qualified Healthcare Professional - Moderate Sedation

[1CodingTeam24]

For an outpatient procedure with moderate sedation codes 99152-99157 performed in POS 11, is a qualified RN (not NP, not CRNA) to perform the moderate sedation considered a QHP and is the moderate sedation separately reimbursable? Must the Moderate sedation codes be billed on the same claim as the physician professional component?

 

[jkyles]

Hi there, to the first question: No. The "independent trained observer" in the descriptors for 99151-99153 is usually an RN with the appropriate training, but they aren't a QHP as defined in the CPT manual, they aren't performing the service and of course they can't report their services.

I also recommend reviewing the information on moderate sedation in the Anesthesia guideline in your CPT manual. Codes 99151-99153 describe moderate sedation performed by the same physician/QHP who performs the procedure.

Codes 99155-99157 are reported when a separate provider administered moderate sedation while another provider performs the procedure, but they can only be reported in a facility setting, so you wouldn't report that in POS 11.

To the second question, when the physician's services meet the requirement for moderate sedation you would report it on the same claim.