How To Use CPT Code 99155

CPT 99155 describes the administration of moderate sedation services to a patient younger than five years of age by a qualified healthcare professional other than the one performing the diagnostic or therapeutic procedure. 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 99155?

CPT 99155 can be used to describe the administration of moderate sedation services to a patient who is younger than five years old. This code is used when a qualified healthcare professional, other than the one performing the diagnostic or therapeutic procedure, administers medication to reduce the patient’s level of consciousness. The sedation should not render the patient unconscious or asleep.

2. Official Description

The official description of CPT code 99155 is: ‘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.’

3. Procedure

1. A qualified healthcare professional, other than the one performing the diagnostic or therapeutic procedure, administers medication to reduce the patient’s level of consciousness.
2. The healthcare professional asks the patient to react purposefully to verbal commands.
3. Further doses of the medication may be administered as required.
4. The healthcare professional monitors the patient until the end of the procedure to ensure their condition is stable.

4. Qualifying circumstances

CPT 99155 is used for patients who are younger than five years of age and require moderate sedation services during a diagnostic or therapeutic procedure. The sedation is administered by a qualified healthcare professional who is not the one performing the procedure. The patient should be able to react purposefully to verbal commands during the sedation.

5. When to use CPT code 99155

CPT code 99155 should be used when a qualified healthcare professional, other than the one performing the diagnostic or therapeutic procedure, administers moderate sedation services to a patient younger than five years of age. This code should not be used if the patient is five years of age or older.

6. Documentation requirements

To support a claim for CPT 99155, the healthcare professional must document the following information:

• Patient’s age
• Procedure for which the sedation was administered
• Medication(s) used for sedation
• Start and end time of the sedation administration
• Monitoring of the patient’s condition during the procedure
• Signature of the qualified healthcare professional administering the sedation

7. Billing guidelines

When billing for CPT 99155, ensure that the sedation services are provided by a qualified healthcare professional other than the one performing the diagnostic or therapeutic procedure. The sedation should be administered to a patient younger than five years of age. If additional time is spent on the sedation administration, report each additional 15 minutes with CPT code 99157. Do not report CPT 99155 if the patient is five years of age or older, in which case CPT 99156 should be used instead.

8. Historical information

CPT 99155 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 nurse administering moderate sedation services to a three-year-old patient during a dental procedure.
2. A pediatrician providing moderate sedation services to a two-year-old patient during a minor surgical procedure.
3. A nurse anesthetist administering moderate sedation services to a four-year-old patient during an MRI scan.
4. A pediatric dentist providing moderate sedation services to a five-year-old patient during a tooth extraction.
5. A pediatric surgeon administering moderate sedation services to a one-year-old patient during a minor surgical procedure.
6. A nurse anesthetist providing moderate sedation services to a three-year-old patient during a colonoscopy.
7. A pediatrician administering moderate sedation services to a four-year-old patient during a bone marrow aspiration.
8. A nurse anesthetist providing moderate sedation services to a two-year-old patient during a cardiac catheterization.
9. A pediatric dentist administering moderate sedation services to a three-year-old patient during a dental filling.
10. A nurse providing moderate sedation services to a one-year-old patient during a minor surgical procedure.