How To Use CPT Code 99153

CPT 99153 refers to moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service, requiring the presence of an independent trained observer to assist in monitoring the patient’s level of consciousness and physiological status for each additional 15 minutes intraservice time. This article will cover the description, procedure, qualifying circumstances, when to use, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT code 99153.

1. What is CPT 99153?

CPT 99153 is a medical billing code used to describe moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service. This code is specifically used for each additional 15 minutes of intraservice time beyond the initial 15 minutes covered by the primary code. The presence of an independent trained observer is required to assist in monitoring the patient’s level of consciousness and physiological status during the procedure.

2. 99153 CPT code description

The official description of CPT code 99153 is: “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; each additional 15 minutes intraservice time (List separately in addition to code for primary service)”.

3. Procedure

The 99153 procedure involves the following steps:

  1. The provider administers medication to reduce the patient’s level of consciousness, but not render them unconscious or asleep.
  2. An independent trained observer is present to assist in monitoring the patient’s level of consciousness and physiological status.
  3. The provider asks the patient to react purposefully to verbal commands.
  4. Additional doses of medication may be administered as required.
  5. The provider monitors the patient until the end of the procedure, ensuring their condition is stable at that time.
  6. This code is used for each additional 15 minutes of intraservice time beyond the initial 15 minutes covered by the primary code.

4. Qualifying circumstances

Eligibility for CPT code 99153 services depends on the following qualifying circumstances:

  • The patient is undergoing a diagnostic or therapeutic procedure that requires moderate sedation.
  • The same physician or other qualified health care professional performing the procedure is also administering the moderate sedation.
  • An independent trained observer is present to assist in monitoring the patient’s level of consciousness and physiological status.
  • The additional 15 minutes of intraservice time is beyond the initial 15 minutes covered by the primary code.

5. When to use CPT code 99153

It is appropriate to bill the 99153 CPT code when the following conditions are met:

  • The patient is undergoing a diagnostic or therapeutic procedure that requires moderate sedation.
  • The same physician or other qualified health care professional performing the procedure is also administering the moderate sedation.
  • An independent trained observer is present to assist in monitoring the patient’s level of consciousness and physiological status.
  • The additional 15 minutes of intraservice time is beyond the initial 15 minutes covered by the primary code.

6. Documentation requirements

To support a claim for CPT 99153, the following information needs to be documented:

  • The diagnostic or therapeutic procedure being performed.
  • The physician or other qualified health care professional administering the moderate sedation.
  • The presence of an independent trained observer assisting in monitoring the patient’s level of consciousness and physiological status.
  • The duration of the additional intraservice time beyond the initial 15 minutes covered by the primary code.
  • Any additional doses of medication administered, if applicable.
  • The patient’s condition at the end of the procedure.

7. Billing guidelines

When billing for CPT code 99153, keep in mind the following guidelines and rules:

  • Use 99153 in conjunction with 99151 and 99152.
  • Do not report 99153 in conjunction with 99155 and 99156.
  • List 99153 separately in addition to the code for the primary service.
  • Ensure that all documentation requirements are met to support the claim.

8. Historical information

CPT 99153 was added to the Current Procedural Terminology system on January 1, 2017. There have been no updates since its addition.

9. Similar codes to CPT 99153

Five similar codes to CPT 99153 and how they differentiate are:

  1. CPT 99151: This code is used for the initial 15 minutes of intraservice time to administer moderate sedation to a patient younger than five years of age.
  2. CPT 99152: This code is used for the initial 15 minutes of intraservice time to administer moderate sedation to a patient five years of age or older.
  3. CPT 99155: This code is for moderate sedation services provided by a different physician or other qualified health care professional, not performing the diagnostic or therapeutic service, for patients younger than five years of age.
  4. CPT 99156: This code is for moderate sedation services provided by a different physician or other qualified health care professional, not performing the diagnostic or therapeutic service, for patients five years of age or older.
  5. CPT 99157: This code is for each additional 15 minutes of intraservice time for moderate sedation services provided by a different physician or other qualified health care professional, not performing the diagnostic or therapeutic service.

10. Examples

Here are 10 detailed examples of CPT code 99153 procedures:

  1. A patient undergoing a colonoscopy requires moderate sedation for an additional 15 minutes beyond the initial 15 minutes covered by the primary code.
  2. A patient receiving a bronchoscopy requires an extra 15 minutes of moderate sedation due to difficulty in completing the procedure.
  3. A patient undergoing a complex wound debridement requires an additional 15 minutes of moderate sedation to manage pain and anxiety during the procedure.
  4. A patient receiving a nerve block injection requires an extra 15 minutes of moderate sedation to ensure comfort and cooperation during the procedure.
  5. A patient undergoing a cystoscopy requires an additional 15 minutes of moderate sedation due to the complexity of the procedure.
  6. A patient receiving a lumbar puncture requires an extra 15 minutes of moderate sedation to manage anxiety and discomfort during the procedure.
  7. A patient undergoing a bone marrow biopsy requires an additional 15 minutes of moderate sedation to ensure comfort and cooperation during the procedure.
  8. A patient receiving an endoscopic retrograde cholangiopancreatography (ERCP) requires an extra 15 minutes of moderate sedation due to the complexity of the procedure.
  9. A patient undergoing a cardiac catheterization requires an additional 15 minutes of moderate sedation to manage anxiety and discomfort during the procedure.
  10. A patient receiving an esophagogastroduodenoscopy (EGD) requires an extra 15 minutes of moderate sedation due to difficulty in completing the procedure.

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