How CMS removing moderate sedation value from GI codes will affect GI & endoscopy physicians: 8 points

CMS plans to remove the value of moderate sedation from over 120 GI endoscopy codes, according to a report by the American Gastroenterological Association.

Here are eight points:

1. The new measure aims to prevent duplicative payment to the endoscopist for moderate sedation when anesthesia is provided and billed by a second provider.  

2. Current Procedural Terminology, or CPT, has created new codes to describe administration of moderate sedation when performed by the endoscopist, which will become effective in 2017.

3. CMS says no extra value will be added when the new CPT codes for moderate sedation are reported with the GI endoscopy procedure.

4. Endoscopists administering moderate sedation during procedures will likely report these new moderate sedation codes along with the underlying procedural code.

5. Endoscopists not administering moderate sedation will only report the underlying procedural code.

6. Anesthesiology professionals who administer anesthesia during GI endoscopy procedures will continue to be reimbursed separately for their work.

7. GI societies, including the AGA, American College of Gastroenterology and American Society for Gastrointestinal Endoscopy, are disappointed by the new measure as it may lead to further reduction in GI endoscopy reimbursement if the endoscopist doesn't administer moderate sedation.

8. The AGA and other societies are advocating for the need for appropriate valuation of moderate sedation that preserves the value of the endoscopy procedures.

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