How To Use CPT Code 99151

CPT 99151 describes the administration of moderate sedation services to a child under the age of five by a physician or other qualified healthcare professional. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 99151?

CPT 99151 can be used to describe the administration of moderate sedation services to a child under the age of five by a physician or other qualified healthcare professional. This code is used when the provider administers medication to reduce the patient’s level of consciousness, with the presence of an independent trained observer to assist in monitoring the patient’s level of consciousness and physiological status. CPT 99151 represents the initial 15 minutes of intraservice time.

2. Official Description

The official description of CPT code 99151 is: ‘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.’

3. Procedure

1. The physician or qualified healthcare professional performs a diagnostic or therapeutic procedure on a child under the age of five.
2. The provider administers medication to reduce the patient’s level of consciousness, with the presence of an independent trained observer.
3. The provider asks the patient to react purposefully to verbal commands and administers further doses of the drugs as required.
4. The provider monitors the patient until the end of the procedure and ensures the patient’s condition is stable.

4. Qualifying circumstances

CPT 99151 is used when a physician or other qualified healthcare professional administers moderate sedation services to a child under the age of five. The sedation supports a diagnostic or therapeutic service, and the presence of an independent trained observer is required to assist in monitoring the patient’s level of consciousness and physiological status.

5. When to use CPT code 99151

CPT code 99151 should be used when a physician or other qualified healthcare professional administers moderate sedation services to a child under the age of five. This code represents the initial 15 minutes of intraservice time. If additional time is required, CPT code 99153 should be reported for each additional 15 minutes of moderate sedation.

6. Documentation requirements

To support a claim for CPT 99151, the provider must document the following information:

• Patient’s age (must be younger than five years old)
• Procedure performed and the need for moderate sedation
• Medications administered and doses given
• Presence of an independent trained observer
• Monitoring of the patient’s level of consciousness and physiological status
• Stability of the patient’s condition at the end of the procedure

7. Billing guidelines

When billing for CPT 99151, ensure that the sedation services are provided by the same physician or qualified healthcare professional performing the diagnostic or therapeutic service. The presence of an independent trained observer is required. If additional time is spent on moderate sedation, report CPT code 99153 for each additional 15 minutes. It is important to note that CPT code 99151 should not be reported with CPT codes 99152 or 99153 for patients five years of age or older.

8. Historical information

CPT 99151 was added to the Current Procedural Terminology system on January 1, 2017. There have been no updates to the code since its addition.

9. Examples

1. A pediatrician administering moderate sedation services to a four-year-old patient during a minor surgical procedure.
2. An anesthesiologist providing moderate sedation services to a three-year-old patient undergoing a dental procedure.
3. A gastroenterologist administering moderate sedation services to a two-year-old patient during an endoscopy.
4. A surgeon performing a minor procedure on a five-year-old patient without the need for moderate sedation.
5. An emergency room physician providing moderate sedation services to a four-year-old patient during the reduction of a dislocated joint.
6. A cardiologist administering moderate sedation services to a three-year-old patient during a cardiac catheterization.
7. A radiologist providing moderate sedation services to a two-year-old patient during a magnetic resonance imaging (MRI) scan.
8. A dermatologist performing a skin biopsy on a five-year-old patient without the need for moderate sedation.
9. An ophthalmologist administering moderate sedation services to a four-year-old patient during a strabismus surgery.
10. A urologist providing moderate sedation services to a three-year-old patient during a cystoscopy.