Getting Your Moderate Sedation Medical Billing Codes Straight

In late 2006, the CPT added some new codes in their revision. Previously there would have been a need to bill for extra units to capture a procedures base units. With the release of the new moderate sedation codes (99143-99150). The need to bill extra units to capture the procedure’s base unit amounts. Therefore, you should ignore billable units and instead use new time-based codes.

A good example would be if a doctor did a procedure that involved 30-minutes of sedation. Previously you would have use 01922 anesthesia designation, you would have used 7 base units and 2 time units (15 minutes = 1 time unit) and you have used the method of billing 01922 x 9. Now with the revised coding you would simply use the age appropriate procedure coding for the services and the range of time units to be billed.

A word of caution, do not use the physical status modifiers with the new claims as they do not apply. Make sure you have proper documentation with your medical billing claims to insure the carrier makes full reimbursement. If your medical billing claim is submitted with little to no documentation, the carrier may make the decision to only pay a portion of the claim or to outright reject your medical billing claim, which means a little more paperwork and time lost on the reimbursement for having to refile your medical billing claim.

Keep up to date with the fast changes in the medical billing industry and make sure your office is coding your claims properly. Using outdated coding can cause you to be receiving less on your reimbursements. If you’re tired of doing the paper chase, consider the benefits of outsourcing your medical billing. You and your staff don’t have to spend time coding and filing claims, appealing rejections and tracking reimbursements, your medical billing partner can do all of that for you and give you time to keep your practice running smoothly and continuing to grow.

View all Articles by: Kathryn Etienne, CCS-P