The 13-page document cleans up several portions of sections 50 and 140 in Internet-only manual 100-04. However the new guidance for moderate sedation is a little light:
Practitioners will report the appropriate CPT and/or HCPCS code that describes the moderate sedation services furnished during a patient encounter, which are furnished in conjunction with and in support of a procedural service, consistent with CPT guidance.
Refer to §50 and §140 of this chapter for information regarding reporting of anesthesia services furnished in conjunction with and in support of procedural services.
However, CMS did address the use of moderate sedation when it is used for colorectal cancer screening colonoscopies.
In
Change Request 10075: Payment for moderate sedation services furnished with colorectal cancer screening tests, the agency clarifies that copayment and deductible waivers do apply to moderate sedation codes
G0500 (Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that 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; patient age 5 years or older) and add-on code
99153 if necessary.
In addition, providers should use modifiers 33 (Preventive services) or PT (Colorectal cancer screening test; converted to diagnostic test or other procedure) as appropriate.
CMS did not address moderate sedation codes 99155-99157, which are used by a provider who performs the moderate sedation while a second provider performs the service.
Want detailed guidance on the new moderate sedation codes? Get the on-demand recording of DecisionHealth's
Wake up to moderate sedation changes webinar, recorded March 16. It will bring you up to speed and it's worth 1 CEU from the AAPC and BMSC.