Wiki 95816 Denial

[mjlan_72@yahoo.com]

I am stumped on this one. Doc did an EEG awake and 95816 was billed. Insurance is denying stating medical records submitted include that EEG was performed. However, the records didn't include recording in awake and drowsy state. I can’t find an EEG code for alert only. Any suggestions/ appeal examples?

Here is an example of the report:

Thank you for any help!
Mary Jo

 

[mjlan_72@yahoo.com]

Does anyone have any suggestions? Still having issues with this denial.

 

[lnemeth89]

I'm following this thread as well. We have never had a problem billing the EEG's for the professional component when in the hospital and now UHC has been denying all of them for this same reason. Any suggestions?