More than 700 code changes will be implemented with the American Medical Association 2017 updates to the Current Procedural Terminology, or CPT. Over half of these changes are related to the removal of the bullseye symbol.
The bullseye symbol is used to identify codes that include moderate sedation as part of the procedure – that is, sedation was considered part of the procedure code when it was performed in conjunction with the procedure.
Removing this symbol from these codes means that going forward the codes will reference the procedure only. Moderate sedation, even when performed with a procedure, will need to be coded separately.
The new CPT moderate sedation codes, which range from 99151 to 99157, also employ a more exact method of valuation. All current moderate sedation codes will be replaced with new codes that are based on 15 minute increments instead of the existing 30 minute increments. To satisfy the conditions of this change, every 15 minutes of face-to-face time with the patient, from the moment the physician administers the sedation until it is safe to step away, will need to be coded and reported on a separate claim line.
The number of bullseye codes utilized in emergency medicine is relatively small; however, some of the emergency procedure codes that will be affected have larger Relative Value Units, or RVUs. RVUs are the values Medicare assigns to a procedure. When multiplied by the conversion factor and geographic adjustment, the RVU indicates the physicians’ compensation level for procedures.
As a result of removing the bullseye, the RVU for some emergency procedures will be reduced. For example, emergency procedures affected by the bullseye removal and subsequently diminished RVUs, are:
- 32551 – Tube thoracostomy
- 33010 – Pericardiocentesis
- 33210 – Insertion of temporary transvenous pacemaker
- 36555 – Insertion of CVP, younger than age 5
- 36568 – Insertion PICC line, younger than age 5
- 92953 – Temporary transcutaneous pacing
- 92960 – Elective cardioversion
As an emergency department physician, it is essential to take note of the 2017 CPT changes for moderate sedation. The new moderate sedation codes need to be reported separately, for each 15 minute interval of intraservice time spent with the patient, to ensure proper coding and billing of your services.
Watch for a future article on the new moderate sedation codes for 2017.