conscious sedation code 99153 professional billing tech only updates?

The CPT book has this codes listed and appears to be a billable service. However the National RVU table has 99153 as technical only. We had heard that this was an error and was going to be changed in April 2017. We then heard that his was not true. If anyone has news from CMS can you please share. Better yet, if someone from CMS or the AMA is reading this can you please clarify this code and why it is not covered when the types of services would be performed in a facility setting.

Thank you
Yvette Hofmeister, CPC
Senior Coder -OSUP

Comments

  • Good Morning Yvette,

    I spoke with a rep at CMS after we started receiving denials for 99153 and she told me that this code is technical only and can only be billed by the hospital. The only way that the doctors can be paid if the procedure is done in an office setting she informed me. My answer to her was, there is not a procedure that someone needs conscious sedation for that can be done in an office setting and her answer was that is the CMS rule.

    Hopefully enough providers will yell and scream and hope that CMS overturns this rule. There was no direction on how these conscious sedation codes would be paid until after the fact of everyone starting to code and bill them. The bottom line as per CMS is the providers will only be paid for the first 15 minutes of conscious sedation.

    Hope this helps.

    Thanks
    Patricia
    Patricia Sparta, CPC Certified Coder – EvergreenHealth Heart & Vascular Care
    PESparta@evergreenhealthcare.com
    425-899-1317 (P) 425-899-1316 (F) EvergreenHealth MS-88, 12333 NE 130th Lane, Ste 320, Kirkland, WA 98034
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  • Amanda,
    This is interesting.
    JK
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