Wiki Moderate Sedation by CRNA in office setting

[mkemak]

I work for a Neurosurgery office and we have started doing procedures in the office that require moderate sedation. We have a CRNA on site who performs the sedation portion and she works side by side with the operating provider. We've been struggling with getting the claims paid for sedation billing. I am completely new to billing for sedation and have been researching proper billing/coding guidelines but I have not found a lot of resources regarding this. We have been billing 99156/99157 with modifiers QX and the patient status modifiers [P modifiers] under the CRNA. I've called the insurance companies and they haven't offered much information and refer me back to their policies which I've been through multiple times. I'm obviously missing a big piece of information and I'm looking for any references or information to help guide us in the right direction. Thank you in advance for any information!

 

[jkyles]

Hi there, unfortunately, that scenario (proceduralist + 2nd provider performing moderate sedation) isn't an option in the non-facility setting. Check the guidelines for the Anesthesia chapter in your CPT Manual, which specify that codes 99155-99157 are performed in the facility setting. (I wish this information was in the section for moderate sedation or mentioned in the moderate sedation section because it is very confusing and there's no way to tell from the codes or the moderate sedation guidelines.)

Codes 99151-99153 are appropriate for the non-facility setting, but they describe the services of a proceduralist who also performs moderate sedation while supervising a trained independent observer. For example 99151 (emphasis added):

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 younger than 5 years of age.