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Codes for moderate sedation are chosen and assigned based on three primary factors Two codes (92978 and 92979, which describe endoluminal imaging of coronary vessel or graft) no longer bundle moderate sedation, but also include additional descriptor changes. Who adminsters the sedation, patient age, and the intraservice time.
The cpt code 99153 represents additional time performed by the nurse (or other personnel) A total of 441 (mostly endoscopic) cpt® codes no longer include moderate sedation, with no further changes to the code descriptors Since the nurse is employed by the facility, incident to billing is not appropriate
Therefore, cpt code 99153 is not payable to the physician since that nurse does not work for him/her, hence the pc/tc indicator 3.
Although many factors affect procedural code selection in 2017, there is a calculator to make it easier To capture moderate sedation reimbursement appropriately, it’s important for you to calculate time and to report the new codes correctly We are facing issues with conscious sedation codes 99152 and 99153 Whenever we bill these conscious sedation codes in conjunction with colonoscopy codes, anthem bcbs and uhc insurance are denying 99152 and 99153 stating it is bundled with colonoscopy codes (45378, 45385, 45380)
Ptp edits are implemented april 1, 2017
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