ED Coding and Reimbursement Alert

Question: A 2-year-old patient reports to the ED. The father says the baby has not defecated in four days, and has been crying almost nonstop for the past 12 hours. The physician takes a detailed history and during a detailed exam, the physician diagnoses fecal impaction. The physician performs sedation with Versed and performs disimpaction; she then counsels the father on caring for the child and recommends a follow-up visit with the child's primary care physician within two weeks. I reported 45915 for the dismpaction and got a denial. What happened? Ohio Subscriber Answer: You should have coded the disimpaction differently. When you re-submit the claim, report the following: • 99143 (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 [...]