How Will the Moderate Sedation (MS) Rule Impact Urology Medical Billing in 2017?

No game is ever played with the same rules. Right from American Football to Soccer and Baseball, the rules of the game keep on changing drastically to suit the changing environment. The same logic, if applied in terms of medical coding requirements, also leads to the same way, the only difference remaining that in sport the passion of the players and fans are involved, and in managing a physician’s business a well-organized Urology Medical Billing Company is required.

It’s an ideal opportunity to start adjusting your senses to the new reality about Moderate Sedation coding. For years, most of you have trained yourself to not report your provider’s moderate sedation separately, when CPT marked the procedure code encircling the center dot symbol and listed the code in Appendix G.

However, times have changed, the President has changed and in 2017 Medicare Physician Fee Schedule and CPT 2017 want to change all that. This year CPT removes the symbol from more than 400 codes, and that means you need to report the moderate sedation code if you want to be paid for it.

Similarly, codes for vascular procedures, electrophysiology, and gastroenterology procedures dictate the list of codes that carried the moderate sedation symbol last year and in 2015, so if your Urology Medical Billing and Coding department codes for those services, you will have to pay particular attention to the changes coming for moderate sedation.

Moderate Sedation Coding Changes, what exactly are they?

Numerous coders looking at the rundown of 2017 code changes were perplexed by the quantity of codes marked as revised that had no obvious change to their descriptors. The appropriate answer for this is the correction was the removal of the moderate sedation symbol, demonstrating you should report a moderate sedation code independently in 2017 to get paid for providing that services with the procedures.

A lot of urology codes will be subjective by this change, including codes for percutaneous renal biopsy and ablation, internally dwelling ureteral stent services, nephroureteral, and nephrostomy catheter services, and others. So make sure your practice becomes acquainted with the new rules for filing claims related to moderate sedation to guarantee you get each dollar your practice merits in 2017.

Concentrate on Age and Time to Find Right Codes

Along with changing the rules for reporting moderate sedation, CPT changes the codes as well. CPT 2017 has erased the current Moderate Sedation codes 99143-+99150. The substitution codes are like the old codes with a few varieties in time requirements; however, if you never utilized the old codes, that news doesn’t help much.

You’ll choose these 2017 codes when a doctor or other healthcare professionals gives the MS to a procedure he/she is performing herself:

• 99151, Moderate sedation administrations provided by the same doctor or other qualified healthcare professional giving the diagnostic services that the sedation supports, requiring the presence of an independent and 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 of intra-service time (list separately in addition to code for primary service).

Points to Remember

• Code 99151 applies to the initial 15 minutes of MS administrations for a patient younger than five. If the patient is five or above, utilize 99152 for the initial 15 minutes. Code +99153 applies to each extra 15 minutes regardless of the patient’s age.

Important: Additional new codes 99155, 99156, and +99157 look like 99151-+99153, however, use them only when somebody other than the surgical supplier plays out the moderate sedation administrations.