Clarifying Time Reporting for Sedation

Due to the ongoing confusion regarding the new sedation codes, D9223 and D9243, guidance has been sought from the ADA and multiple private insurance payers for clarification on the proper reporting of time increments. This is what was learned:

An ADA News Online article dated January 28, 2016 explains how and why changes were made to these codes. Included in that article is a statement that these new CDT codes report anesthesia time periods in a similar manner as the previous CDT codes. This means that any amount of time up to the full number of minutes cited in the nomenclature (i.e., 15 minutes) would be reported with a single usage of the appropriate code. In other words, up to 15 minutes of anesthesia is reported by each code. (For example, if 20 minutes of anesthesia time is provided, report the appropriate code, with a Quantity of 2 in Box 29b.)

The private insurance carriers contacted advised that all practices should review any payer processing policies and PPO contracts, as some payers may not reimburse anesthesia time of less than thefull 15-minute increment.