How To Use CPT Code 99156

CPT 99156 describes the administration of moderate sedation services 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 99156?

CPT 99156 can be used to describe the administration of moderate sedation services by a qualified healthcare professional to a patient who is five years of age or older. This code is used for the initial 15 minutes of intraservice time, during which the healthcare professional administers medication to reduce the patient’s level of consciousness without rendering them unconscious or asleep.

2. Official Description

The official description of CPT code 99156 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 age 5 years or older.’

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 ensures the presence of an independent trained observer during the procedure.
3. The healthcare professional asks the patient to react purposefully to verbal commands and administers additional doses of medication as required.
4. The healthcare professional monitors the patient until the end of the procedure and ensures their condition is stable.

4. Qualifying circumstances

CPT 99156 is applicable when a patient who is five years of age or older requires moderate sedation services during a diagnostic or therapeutic procedure. The healthcare professional administering the sedation must be qualified and independent from the provider performing the procedure. The patient’s level of consciousness should be reduced without rendering them unconscious or asleep.

5. When to use CPT code 99156

CPT code 99156 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 who is five years of age or older. This code is specifically for the initial 15 minutes of intraservice time. If additional time is required, CPT code 99157 should be reported.

6. Documentation requirements

To support a claim for CPT 99156, the healthcare professional must document the following information:

• Patient’s age (must be five years or older)
• Procedure for which the sedation was administered
• Medications administered and their dosages
• Start and end time of the intraservice period
• Presence of an independent trained observer
• Patient’s level of consciousness and ability to react purposefully to verbal commands
• Monitoring of the patient’s condition until the end of the procedure

7. Billing guidelines

When billing for CPT 99156, ensure that the healthcare professional administering the sedation is qualified and independent from the provider performing the procedure. This code should only be reported for the initial 15 minutes of intraservice time. If additional time is required, CPT code 99157 should be used. It is important to note that CPT code 99156 should not be reported if CPT codes 99166 to 99168 have already been performed in the previous seven days.

8. Historical information

CPT 99156 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 patient undergoing a colonoscopy.
2. A dentist providing moderate sedation to a patient during a dental procedure.
3. A gastroenterologist administering moderate sedation to a patient undergoing an endoscopy.
4. An orthopedic surgeon using moderate sedation for a patient receiving a joint injection.
5. A dermatologist providing moderate sedation to a patient during a skin biopsy.
6. A cardiologist administering moderate sedation to a patient undergoing a cardiac catheterization.
7. An ophthalmologist using moderate sedation for a patient receiving an eye surgery.
8. A radiologist providing moderate sedation to a patient during a radiological procedure.
9. An obstetrician-gynecologist administering moderate sedation to a patient undergoing a hysteroscopy.
10. A urologist using moderate sedation for a patient receiving a cystoscopy.