Updates

Moderate (Conscious) Sedation

You are now permitted to bill separately.
99152 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 intraservice time, patient age 5 years or older

99153 Each additional 15 minutes
99156 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 intraservice time, patient age 5 years or older

99157 Each additional 15 minutes
Documentation points:
Pre service (do not include in time)

  1. Assessment/Documenting PMFS history regarding sedation or anesthesia and drug allergies
  2. Summary of meds list
  3. Exam of Vitals, Airway, Chest, Lungs, Heart and circulation
  4. Completion of pre sedation assessment form that includes the ASA physical status classification.

Intraservice (Timing begins)

  1. Timing begins when sedation started and ends the patient is stable for recovery status.
  2. Administering initial and subsequent doses (type and amount)
  3. Continuous face to face attendance
  4. Documenting periodic assessment, O2 sats, heart rate and BP

Post service (do not include in time)

  1. Post sedation assessment, Vitals, CV and pulmonary stability, level of consciousness.
  2. Discharge readiness and family updates

Bronchoscopy- wRVU (reimbursement) was deceased because CPT/AMA/CMS have unbundled the moderate sedation work from these codes.
You can be billed with Critical Care, Emergency medicine and Initial Visit codes just the same as other procedures, the visit encounters are separately and identifiable evaluation and management services.
You cannot bill them on the same day with a subsequent visit or observation visit

Approximate Medicare reimbursement
99152 $12.22 MS same provider with independent observer
99153 $10.29
99156 $75.00 MS with different performing provider
99157 $57.06

End of Life discussions

CPT/AMA description

Advance care planning face to face service with the patient, family member, or surrogate discussing advance directive with or without completing relevant legal forms. The advanced directive is a document appointing an agent and/or recording the wishes of a patient pertaining to his/her medical treatment at a future time should he/she lack decisional capacity at the time. When using 99497 99498 no active management of the problems is undertaken during the time period report.

Medicare description

Voluntary advance care planning means the face-to-face service between a physician (or other qualified health care professional) and the patient discussing advance directives, with or without completing relevant legal forms. An advance directive is a document appointing an agent and/or recording the wishes of a patient pertaining to his/her medical treatment at a future time should he/she lack decisional capacity at that time.

Not reportable with 99291 on the same day but they can be used with other evaluation and management codes. It should be a separate encounter note when bill with a medical service (EM) code on the same day.

When the patient is critically ill and the decision to withdrawal or initiate treatment is being determined that critical care is billed.

Medicare does not have any specific documentation requirements on it yet. However, since it is a timed code; the time spent would have to documented, who was involved in the discussion and as well as what conditions are warranting the discussion, the management options of the condition(s) that were discussed and what the outcome(s) decision are.

Some Medicare carriers allow for the guideline from the CPT manual of ½ time to meet the thresholds

Critical Care and Telehealth

Medicare now has HCPCS codes for Telehealth Critical Care

G0508 - Telehealth Critical Care initial, physician typically spends 60 minutes communicating with the patient and providers via telehealth.

G0509 - Telehealth Critical Care subsequent, physician typically spends 50 minutes communicating with the patient and providers via telehealth.

The GT modifier will need applied to telehealth codes.
You must verify that the originating site is a facility in HRSA area.