CPT Code Changes for 2017

This “In the kNOW” topic addresses a major change in CPT coding for 2017 regarding moderate (conscious) sedation.  This type of sedation allows a patient to purposefully respond when given verbal commands after being medicated.  It is not necessary to provide airway or cardiovascular support, and the patient’s own breathing is sufficient.  In the past, moderate sedation was considered part of select CPT codes and identified by the presence of an encircled bullet symbol, like this:

Effective January 1, 2017, there is a new way to code for moderate sedation thus resulting in revisions to many codes.  
 

A review of Appendix B indicates a large number of codes impacted by this change which is also reflected by review of Appendix G which has been removed from CPT.  Review of the explanatory note found under Appendix G provides coders with the information that the moderate sedation symbol, has been removed from the codes it was previously associated with and that is confirmed in Appendix B, where we see the codes preceded by the moderate sedation symbol with a strikethrough, like this: 

Appendix G now refers coders to new CPT codes 99151-99157 in order to capture moderate sedation, and Appendix B indicates that codes 99143-99150 which applied to procedures where it was appropriate to code moderate sedation separately have been deleted.  These new moderate sedation codes are inclusive of preservice, intraservice, and postservice work.  However, the code selection is solely based on the intraservice time as the pre and post work are included in the codes.  Components of the intraservice time include:

• Starts with administration of sedation
• Ends with completion of procedure, determination that patient is stable, and provider face-to-face time concludes
• Initial and subsequent orders and administration of sedation are included
• Continuous face-to-face time by provider is required
• Patient is monitored for sedation response

The new section of moderate sedation codes (99151-99157) are based on 15 minute increments of time as well as the age of the patient, and whether or not the sedation is provided by the same individual who is performing the diagnostic or therapeutic service.  For example, code 99151 is for the first 15 minutes of conscious sedation on a patient who is younger than 5 years old by the same provider performing the diagnostic or therapeutic service.  Add-on codes 99153 and 99157 are for each additional 15 minutes of intraservice time regardless of age.    

Further information on this important change in CPT can be found in the 2017 CPT Manual under Appendices B and G, and in the notes preceding the new CPT codes 99151-99157.  

Now you are In the kNOW!!

If you are interested in learning more about the CPT code updates coming in 2017, register for our webinar on this topic!  

Dianna Foley, the author of this article, will be the presenter on the webinar.  

 See our website for registration and details.

 
About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.