CPT® 2017 & Moderate Sedation: What Gastroenterology Coders Need to Know Now

Fri, Jan 27, 2017 --

CPT Codes

CPT® 2017 & Moderate Sedation

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

4 Comments For This Post

  1. Alma Cocoa Says:

    Hi Deborah,

    I have a quick question regarding HCPCS G0500. Is this code meant to report MCS with GI endoscopy services by the same provider to Medicare only?

    Thanks

  2. Deborah Marsh Says:

    Hi, Alma – That’s an important question! Code G0500 was created for Medicare use, but it’s possible private payers will choose to adopt it. So it’s a payer-by-payer sort of answer. The payer should publish a policy indicating they accept the G code. Based on a quick search, some private payers aren’t reimbursing 99151-99153 or G0500 for now, such as https://www.harvardpilgrim.org/pls/portal/docs/PAGE/PROVIDERS/MANUALS/PAYMENT%20POLICIES/H-2%20GASTROENTEROLOGY_011517.PDF. This site says it reimburses G0500 only for Medicare members: http://www.emblemhealth.com/en/Providers/Claims-Corner/Coding/Moderate-Conscious-Sedation.aspx. With any luck, we’ll start seeing more payer policies with specifics available soon.

  3. Sharon Gerald Says:

    Hi! We have billed Medicare G0500 +99153 and they are denying the 99153 because we are billing in facility -22. Do you know if Medicare is reimbursing for 99153? Thanks,

  4. Deborah Marsh Says:

    Hi, Sharon – The most authoritative information I’ve found on your question about Medicare paying the physician for 99153 in the facility is this bit from Novitas Medicare:
    “3/3/2017 Update: Procedure code 99153 is for reimbursement of the additional practice expense of this procedure only. Codes that reimburse for the practice expense only are not reimbursable to the professional provider when the service is performed in an inpatient setting. Claims for procedure code 99153 billed with an inpatient place of service will not be paid when they are billed by the professional provider.” That information is located here: http://www.novitas-solutions.com/webcenter/portal/MedicareJH/page/pagebyid?contentId=00134802&_adf.ctrl-stat=&_adf.ctrl-state=4qp7vkija_4&_afrLoop=938899616782805#!

    It’s also helpful to know that +99153 has an NA in the MPFS Facility NA Indicator column (which means rarely/never performed in a facility). The code also has a PC/TC indicator of 3, meaning it’s a technical component only code. Hope that’s helpful!

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