How To Use CPT Code 99152

CPT 99152 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 the monitoring of the patient’s level of consciousness and physiological status for patients aged 5 years or older. 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 99152.

1. What is CPT 99152?

CPT 99152 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 patients aged 5 years or older and requires the presence of an independent trained observer to assist in monitoring the patient’s level of consciousness and physiological status.

2. 99152 CPT code description

The official description of CPT code 99152 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; initial 15 minutes of intraservice time, patient age 5 years or older.”

3. Procedure

The 99152 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 performs the diagnostic or therapeutic service supported by the sedation.
4. Additional doses of medication may be administered as needed to maintain the desired level of sedation.
5. The provider monitors the patient until the end of the procedure and ensures their condition is stable.

4. Qualifying circumstances

Patients eligible to receive CPT code 99152 services must meet the following criteria:

• Be 5 years of age or older.
• Require moderate sedation for a diagnostic or therapeutic procedure performed by the same physician or other qualified health care professional providing the sedation.
• Have an independent trained observer present to assist in monitoring their level of consciousness and physiological status during the procedure.

5. When to use CPT code 99152

It is appropriate to bill the 99152 CPT code when a patient aged 5 years or older requires moderate sedation for a diagnostic or therapeutic procedure performed by the same physician or other qualified health care professional providing the sedation, and an independent trained observer is present to assist in monitoring the patient’s level of consciousness and physiological status.

6. Documentation requirements

To support a claim for CPT 99152, the following information must be documented:

• Patient’s age and the need for moderate sedation.
• Details of the diagnostic or therapeutic procedure performed.
• Presence of an independent trained observer and their role in monitoring the patient’s level of consciousness and physiological status.
• Medications administered, including dosage and frequency.
• Duration of the sedation, including start and end times.
• Patient’s condition and stability at the end of the procedure.

7. Billing guidelines

When billing for CPT code 99152, keep in mind the following guidelines and rules:

• Only bill for the initial 15 minutes of intraservice time. For each additional 15 minutes of moderate sedation, report CPT code 99153.
• For the same service for a patient younger than 5 years of age, report CPT code 99151.
• Ensure all documentation requirements are met to support the claim.

8. Historical information

CPT 99152 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 99152

Five similar codes to CPT 99152 and how they differentiate are:

• CPT 99151: Used for moderate sedation services for patients younger than 5 years of age.
• CPT 99153: Used for each additional 15 minutes of moderate sedation beyond the initial 15 minutes covered by CPT 99152.
• CPT 99155: Used for moderate sedation services provided by a different physician or other qualified health care professional than the one performing the diagnostic or therapeutic service, for patients aged 5 years or older.
• CPT 99156: Used for moderate sedation services provided by a different physician or other qualified health care professional than the one performing the diagnostic or therapeutic service, for patients younger than 5 years of age.
• CPT 99157: Used for each additional 15 minutes of moderate sedation provided by a different physician or other qualified health care professional than the one performing the diagnostic or therapeutic service, beyond the initial 15 minutes covered by CPT 99155 or 99156.

10. Examples

Here are 10 detailed examples of CPT code 99152 procedures:

1. A 6-year-old patient undergoing a diagnostic endoscopy with moderate sedation provided by the same physician performing the endoscopy, with an independent trained observer present.
2. An 8-year-old patient receiving moderate sedation for a dental procedure performed by the same dentist providing the sedation, with an independent trained observer present.
3. A 12-year-old patient undergoing a minor surgical procedure with moderate sedation provided by the same surgeon performing the procedure, with an independent trained observer present.
4. A 15-year-old patient receiving moderate sedation for a diagnostic imaging procedure performed by the same radiologist providing the sedation, with an independent trained observer present.
5. An 18-year-old patient undergoing a therapeutic injection with moderate sedation provided by the same physician performing the injection, with an independent trained observer present.
6. A 25-year-old patient receiving moderate sedation for a biopsy performed by the same physician providing the sedation, with an independent trained observer present.
7. A 35-year-old patient undergoing a diagnostic bronchoscopy with moderate sedation provided by the same pulmonologist performing the bronchoscopy, with an independent trained observer present.
8. A 45-year-old patient receiving moderate sedation for a therapeutic joint injection performed by the same physician providing the sedation, with an independent trained observer present.
9. A 55-year-old patient undergoing a minor dermatological procedure with moderate sedation provided by the same dermatologist performing the procedure, with an independent trained observer present.
10. A 65-year-old patient receiving moderate sedation for a diagnostic cardiac catheterization performed by the same cardiologist providing the sedation, with an independent trained observer present.