Wiki EEG denying for awake and drowsy

[lnemeth89]

I work for a multi-specialty practice and our Neurologist bills for EEG's completed in our office and in the hospital setting. Within the past few months we have had a large number of our EEG's deny stating the records not indicate awake and drowsy and there is a more appropriate code to use. Mostly all of our reports document the level of wakefulness for the patient and they are still getting denied. Has anyone else experienced this issue or know of a work around for these denials?

 

[TK11823]

Just had first 95816 denied for that reason...have no idea what it is about.

 

[paul1998@comcast.net]

Did anyone find any answers to this question? We are getting alot of Carefirst denials for 95816 with procedure deemed experimental by the payor. Never had this problem before.

 

[deepshikha]

Our physicians use all the time 95816 and getting paid fees depending on the carrier without problem. Medicaid does not pay if the procedure is done in hospital, because they require pre-authorization, which hospital does not collect. Hope it helps.

 

[lnemeth89]

Our physicians use all the time 95816 and getting paid fees depending on the carrier without problem. Medicaid does not pay if the procedure is done in hospital, because they require pre-authorization, which hospital does not collect. Hope it helps.

I am not questioning our hospital billing, I am questioning why the EEG's are denying stating the records do not indicate awake and drowsy and there is a more appropriate code to use. Our physician documents explicitly and this error was never a problem until recently.