Moderate sedation billing

[itzamemario]

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Do you guys get paid for moderate sedation for procedures in the hospital outpatient dept? I'm RVU based and they said none of the docs get paid for this, but Medicare shows it as 0.5 RVU, so trying to figure out if I'm losing out on money

 

[BobBarker]

Yes, in general, this code gets paid if documented/billed correctly.

 

[Gnarvin]

What CPT code are you referring to? 99152 is 0.25 RVU.

I know Medicare is giving a lot of pushback for moderate sedation for even RFA so maybe the hospital isn’t able to collect from Medicare on those.

 

[BobBarker]

99152 is the correct code. I agree, Medicare does not want us doing moderate sedation for basic interventions. There are a lot of reasons for that which make sense. Cost, procedural safety, post op (fall) safety. I am curious what happens with MAC billing. We have two large offices here who are doing MAC with propofol for most procedures with an independent CRNA.

But back to on topic and I always billed 99152 at the hospital and I always got paid the appropriate wrvu.

 

[Ronin1]

Yes we bill for it. Documentation that we use is” patient received So much fentanyl iv under my direction. Sedation start and finish time. Administration and monitoring performed by an independent trained personnel Nurse ratchet rn. “

 

[mdo1738]

I’m HOPD at Bob’s prior facility. It is 99152 and I have always got my 0.25 RVU for each one. That tiny RVU isn’t enough to make it worth the hassle but it’s better than the nothing that your hospital is falsely telling you.

 

[IAmTheOne1]

Used to bill 99152 but Medicare started blocking claims. Now just give sedation for free since the patients that want it will either chicken out of the procedure otherwise or refuse to self-pay for sedation. So it's just a freebie now. Sucks.

 

[Gnarvin]

99152 is the correct code. I agree, Medicare does not want us doing moderate sedation for basic interventions. There are a lot of reasons for that which make sense. Cost, procedural safety, post op (fall) safety. I am curious what happens with MAC billing. We have two large offices here who are doing MAC with propofol for most procedures with an independent CRNA.

But back to on topic and I always billed 99152 at the hospital and I always got paid the appropriate wrvu.

I apologize, my reply was meant for the OP which I now realize I was not clear on.

 

[itzamemario]

Thank you. To qualify it needs to be 15 minutes and starts when the med is given till when I'm out of the room right?
Does Medicaid or VA/Tricare and private pay usually?

 

[RoloTomassi]

Most our payers stopped paying so we charge self pay for it. But if you are trying to get reimbursed, need to document what meds, doses, who administered, duration of your monitoring, and a medical necessity statement.

 

[drusso]

We charge the patients cash if they want it.

 

[Ferrismonk]

Thank you. To qualify it needs to be 15 minutes and starts when the med is given till when I'm out of the room right?
Does Medicaid or VA/Tricare and private pay usually?

>10 min

 

[myrandom2003]

We do 99152 and have patients sign an ABN. Medicare does not cover to ESI/Facet/SI/joints.

It is covered for other procedures like RFA and SCS

 

[Dr. Ice]

When I first started, MAC for everyone who wanted it. Then at my second group, anesthesia basically said every patient of every insurance except Obamacare exchange patients, comp and some auto had to pay $250, then it rose to somewhere between $300-500, now that I’ve left that group but still retain asc privileges, the new out of network anesthesia group has said anyone can get sedation and it doesn’t matter.

For years I had to spend time with patients setting up procedures and talking to them about a cash pay for a service I wasn’t even providing because the anesthesiologists never wanted to have any conversation with the patient about their own services. It was total bull****.

Now thankfully for the time being, I’m not having to discuss it with anyone