DX denials for new sedation codes 99152-99153 with ESI injections

Messages
40
Location
Kalispell, MT
Best answers
0
We billed an ESI back injection with sedation and MCD is denying based on diagnosis code. It had three codes on it and they said it didn't like two of the codes but of course can't tell you which one. We have been resubmitting to see which one they will accept. We never had an issue with the old sedation codes. Anybody else having issues ??
 

johnsonsr

Contributor
Messages
15
Location
Mobile, AL
Best answers
0
Tricare denials for diagnosis used with 99152

I am a coder in the cardiology field. I have received denials on several different claims to Tricare for the diagnosis code. Diagnosis code paroxysmal a-fib I48.0 with cardioversion. Any one else run across the same issue or used a different diagnosis and received reimbursement?

Thanks,
johnsonsr
 

sarab86

Guru
Messages
116
Location
Fort Myers, FL
Best answers
0
The ESI coded never allowed moderate sedation so you shouldn't be billing now with the new sedation codes. Those codes should only be added to the procedure codes that previously had the bullseye indicator in the 2016 CPT book.
 
Top