How To Use CPT Code 99157

CPT 99157 describes the provision 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, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 99157?

CPT 99157 can be used to describe the additional 15 minutes of intraservice time for moderate sedation services provided by a qualified healthcare professional other than the one performing the diagnostic or therapeutic procedure. This code is used when the provider administers medication to reduce the patient’s level of consciousness and monitors them beyond the initial 15 minutes covered by the primary code.

2. Official Description

The official description of CPT code 99157 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; each additional 15 minutes intraservice time (List separately in addition to code for primary service).’ This code should be used in conjunction with codes 99155 and 99156, and should not be reported with codes 99151 and 99152.

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. An independent trained observer is present to monitor the patient’s condition and ensure their stability.
3. The provider asks the patient to react purposefully to verbal commands and administers additional doses of medication as required.
4. The provider continues to monitor the patient until the end of the procedure, ensuring their condition remains stable.
5. CPT code 99157 is used to report each additional 15 minutes of intraservice time beyond the initial 15 minutes covered by the primary code.

4. Qualifying circumstances

CPT 99157 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. This code is applicable when an independent trained observer is present, and the provider ensures the patient’s stability until the end of the procedure. It is important to note that this code should be used in conjunction with codes 99155 and 99156, and should not be reported with codes 99151 and 99152.

5. When to use CPT code 99157

CPT code 99157 should be used when an additional 15 minutes of intraservice time is required for moderate sedation services provided by a qualified healthcare professional other than the one performing the diagnostic or therapeutic procedure. This code is used to report the extended monitoring and administration of medication beyond the initial 15 minutes covered by the primary code.

6. Documentation requirements

To support a claim for CPT 99157, the healthcare professional must document the following information:

• Details of the primary service for which the sedation supports
• Date, start and end time of the additional 15 minutes of intraservice time
• Medications administered and their dosages
• Monitoring activities performed during the additional time
• Stability of the patient’s condition at the end of the procedure
• Signature of the qualified healthcare professional providing the service

7. Billing guidelines

When billing for CPT 99157, ensure that the healthcare professional providing the service is qualified and distinct from the one performing the diagnostic or therapeutic procedure. This code should be reported in addition to the primary service code and in conjunction with codes 99155 and 99156. It should not be reported with codes 99151 and 99152. It is important to consider the specific guidelines provided by payers and to use appropriate modifiers if required.

8. Historical information

CPT 99157 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 gastroenterologist administers moderate sedation to a patient undergoing a colonoscopy, and an additional 15 minutes of intraservice time is required for monitoring and medication administration.
2. An orthopedic surgeon performs a reduction of a dislocated joint, and a qualified nurse administers moderate sedation to the patient during the procedure. An additional 15 minutes of intraservice time is needed for continued monitoring and medication management.
3. A dentist performs a complex tooth extraction, and a certified dental assistant provides moderate sedation to the patient. An extra 15 minutes of intraservice time is necessary for ongoing observation and medication administration.
4. A dermatologist performs a skin biopsy, and a nurse anesthetist administers moderate sedation to the patient. An additional 15 minutes of intraservice time is required for post-procedure monitoring and medication adjustment.
5. A cardiologist performs a cardiac catheterization, and a qualified nurse administers moderate sedation to the patient. An extra 15 minutes of intraservice time is needed for continued sedation management and patient monitoring.