Up to the minute information for your financial success.
Trouble Viewing? Read The PBN Minute online.
The American Medical Association issued an opinion in June regarding billing practices for Moderate Conscious Sedation services that directly affects many PBN clients. According to the ruling, billing for moderate conscious sedation requires face-to-face intra-service time of 16 minutes or longer. Put another way, billing for moderate sedation session under 16 minutes is now disallowed.
The question arose from an earlier opinion the AMA published regarding the new time rules in CPT 2011.
How to bill for it now . . .
Groups commonly bill using code 99144 . . . which stipulates, "first 30 minutes intra-service time." In order to bill 99144, physician or practitioner will need to perform and document the intra-service, face-to-face time of the moderate sedation was at least 16 minutes to bill it at all, and more than half the time unit to bill for longer periods of time.
The new time rules in CPT 2011 state the following:
"The CPT code set contains many codes with a time basis for code selection. The following standards shall apply to time measurement, unless there are code or code-range specific instructions in guidelines, parenthetical instructions, or code descriptors to the contrary. Time is the face-to-face time with the patient . . . . A unit of time is attained when the mid-point is passed. " [Emphasis added.] For example, an half-hour is attained when 16 minutes have elapsed (more than the midway between zero and 30 minutes).
This limitation applies to all Medicare claims, and since this is an AMA opinion, it's industry standard and applies to all payers. It may be possible to circumvent the ruling by obtaining a different opinion in writing from a specific payer (assuming your contract with the payer allows coverage variations outside AMA rulings).
What you can do about it . . .
PBN informally tried to pursuade the AMA to change its ruling to allow billing for any length of time at the 30 minute rate, but without success. Individual practitioners and members of practice specialty ssocieties can express their opinions about the ruling and request an amendment to the moderate sedation codes directly to the AMA. Contact information is available on their website at https://extapps.ama-assn.org/contactus/contactusMain.do. AMA plans to address the issue in its fall CPT Assistant newsletter.
PBN has published a draft policy statement to help its clients better understand and deal with the ruling (available on the PBN website). For specific information about how the ruling may affect your practice and what PBN is doing to help, contact a PBN client liaison at .
For more information and guidance on this and other issues that affect your bottom line, contact . . .
PBN Business Development, 800.288.4901,
All content © 2011 Physicians Business Network | 10950 Grandview Suite 200
Overland Park, KS 66210 | 800.288.4901 | pbnmed.com
Opt-in to subscribe. | Opt-out to unsubscribe.