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Monthly Archives: August 2017

Update On Moderate Sedation Coding

For 2017, the AMA revised the codes and coding rules for moderate (conscious) sedation. In prior years, moderate sedation was bundled to with nearly 450 CPT® codes. Now, moderate sedation always is reported and paid separately, when medically necessary and properly documented.
99155 Moderate sedation services provided by a physician or other qualified healthcare professional other than the physician or other qualified healthcare professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age 99156 … initial 15 minutes of intraservice time, patient age 5 years or older 99157 … each additional 15 minutes intraservice time (List separately in addition to code for primary service)
In these cases, the provider performing the moderate sedation (not the provider performing the primary procedure) will bill for the moderate sedation. No independent observer is necessary to monitor the patient. When the same provider performs the primary procedure and the moderate sedation, the appropriate codes are:
99151 Moderate sedation services provided by the same physician or other qualified healthcare 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 99152 …initial 15 minutes of intraservice time, patient age 5 years or older 99153 … each additional 15 minutes intraservice time (list separately in addition to code for primary service)

Updated Prior Authorization Rules for DMEPOS

The Centers for Medicare and Medicaid Services (CMS) have released an update to the prior authorization process for certain durable medical equipment, prosthetic, orthotics, and supplies (DMEPOS) items.
As originally announced in the Federal Register, published on December 21, 2016, CMS is preparing for the nationwide expansion of the prior authorization process for the first two items of durable medical equipment to be subject to required prior authorization beginning on July 17, 2017:
K0856: Power wheelchair, group 3 std., single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0861: Power wheelchair, group 3 std., multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
Suppliers or beneficiaries submitting the first claims in the series for these items must receive prior authorization before the item is furnished or a claim is submitted, as a condition for payment. Durable medical equipment Medicare administrative contractors (DME MACs) began accepting prior authorization requests for this expansion July 3, 2017.

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