January 2017

A major change in coding for bronchoscopy occurs on Jan. 1, 2017, as moderate (conscious) sedation becomes separately identified from the work relative value units (wRVUs) for the bronchoscopy codes.  While traditionally the bronchoscopist provided moderate sedation, in recent clinical practice other individuals often provide the sedation.  The Centers for Medicare/Medicaid Services (CMS) mandated refinement of separate Current Procedural Terminology (CPT) codes to account for the work of moderate procedural sedation.  In the final rule published in Nov. 2016, CMS removed 0.25 wRVUs from many of the bronchoscopy codes to account for the work of moderate sedation.  Therefore, to be reimbursed appropriately, one needs to include a moderate sedation CPT code with ALL bronchoscopy procedures.

Use CPT codes 99151 and 99155 for patients younger than five years.  For patients five years or older, when the bronchoscopist provides moderate sedation, report CPT code 99152 for the initial 15 minutes and 99153 for subsequent time in 15 minute increments.  For patients five years or older, when a provider other than the bronchoscopist provides moderate sedation, use CPT code 99156 for the initial 15 minutes and 99157 for subsequent time in 15 minute increments.  Utilize CPT codes 99156 and 99157 only when a second provider (other than the bronchoscopist) performs moderate sedation in the facility setting (e.g., hospital, outpatient hospital/ ambulatory surgery center, skilled nursing facility); when the second provider performs these services in the non-facility setting (e.g., physician office, freestanding imaging center), do not report codes 99155, 99156, or 99157.  Moderate sedation does not include minimal sedation (anxiolysis), deep sedation, or monitored anesthesia care (00100–01999), all typically provided by anesthetists.

Do not use a moderate sedation code (99151-2 or 99155-6) if providing less than 10 minutes of moderate sedation.  As with other time-based codes, use the subsequent codes 99153 and 99157 when moderate sedation last 8 minutes or longer than the initial 15 minutes.  The time for moderate sedation begins with the administration of the sedating agent, and concludes when the continuous face-to-face presence of the bronchoscopist ends, after completion of the procedure.  Intermittent, re-evaluation of the patient afterward is post-service work, and not included in the time for moderate sedation.  For example, if the bronchoscopist provides moderate sedation for 25 minutes in a 65 year old man, report 99152 (for the initial 15 minutes) and 99153 (for the subsequent 10 minutes).  If an individual other than the bronchoscopist provides moderate sedation for 41 minutes in a 57 year old woman, use 99156 (for the initial 15 minutes) and two units of 99157 (for the subsequent 26 minutes) (see Table 1).

If a bronchoscopist provides moderate sedation and reports the appropriate CPT codes after Jan. 1, 2017, the 0.25 wRVU change will have no financial impact compared to 2016.  However, if a second provider performs the moderate sedation, expect approximately an $8.72 drop (national average) in reimbursement per procedure.

Table 1