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General Surgery Coding Alert

Reader Question:
Meet Mid-Point Requirement for Moderate Sedation

Question: Should we report 99144 and +99145 when the surgeon documents 36 minutes of moderate sedation for a procedure such as 48500 (Marsupialization of pancreatic cyst)? Vermont Subscriber Answer: No -- 36 minutes of moderate sedation earns only 99144 (Moderate sedation services [other than those services described by codes 00100-01999] provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; age 5 years or older, first 30 minutes intra-service time). CPT® guidelines state, \"A unit of time is attained when the mid-point is passed.\" That means to meet the requirement for +99145 (... each additional 15 minutes intra-service time [List separately in addition to code for primary service]), the time needs to be at least 7.5 minutes (half of 15 minutes) beyond the 30 [...]