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

[jovibon110@gmail.com]

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]

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]

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.