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Sedation codes

Posted By Jeffrey Hoggard, Thursday, January 12, 2017

The new coding manual mentions  sedation codes 99152 and 99153. ( p22)   These sedation codes are column 2 codes for all our  column 1 codes (36901-9  )   and therefore are not allowed.   

Still learning the new rules of the game.

Jeff Hoggard MD

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Gerald A. Beathard says...
Posted Thursday, January 12, 2017
This is true; however, it is a mistake on the part of NCII
We have been told that this will be corrected in April
I would suggest that it be billed, expected to be denied and then appeal it as soon as the new NCII edits are released in April
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Chester A. Amedia Jr. says...
Posted Thursday, January 12, 2017
It is possible that there could be a cash flow interruption if 99151-99153 denials affect payment for the entire submitted procedure due to payer specific decisions. For that reason, it might be prudent to withhold submission for payment of moderate sedation until after the NCII correction, and then to back bill. Just a thought...
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Daniel V. Patel says...
Posted Friday, January 13, 2017
I agree with Dr. Amedia's thoughts here.

I too was thinking of holding off submission for sedation codes until April, then to perhaps try to re-file for the sedation components at that time.

The risk here is delaying payments for the higher value codes (PTA/ Stent/Etc..) due to conflicts in reimbursement for relatively lower value sedation codes.

I think it seems reasonable to try to collect the sedation components later. I'm not sure what others have planned to do.
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