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Items Tagged: billing



ZHealth Special Edition Newsletter Revision

Special Edition Newsletter: Moderate Sedation

Revision to 'Professional Billing of Moderate Sedation by the Physician Performing the Procedure When in a Facility Site of Service'

The codes for reporting moderate sedation performed by a physician or other qualified health care professional other than the one performing the procedure do not have different RVUs for the facility and non-facility sites of service. The RVUs are the same. There is also an NA in the NON-FAC NA INDICATOR column of the RVU file. From the CMS document explaining the NA in this field: An “NA” in this field indicates that this procedure is rarely or never performed in the non-facility setting.

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ZHealth Special Edition Newsletter

Special Edition Newsletter: Moderate Sedation

Professional Billing of Moderate Sedation by the Physician Performing the Procedure When in a Facility Site of Service

In the physician RVU file there is a column labeled “PCTC IND” which designates when a code is technical-only or professional-only. The add-on code for each additional 15 minutes of moderate sedation by the physician performing the procedure (99153) is indicated as technical-only (3) in this field. In addition, there is an NA in the RVU file column titled “FACILITY NA INDICATOR”. The NA indicates “that this procedure is rarely or never performed in the facility setting”. Since code 99153 is technical only, a physician cannot report this code when performed in the facility setting.  

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