Wiki Need help on UHC denials/ documentation on 99152 , 99153

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vidraj

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Hello everyone,
Looking for some inputs on this:

UHC has been denying the moderate sedation code 99152 and 99153 for the Cath lab procedures (Diagnostic Coronary angiograms , PM implant procedures)

With the same documentation(shots of the sedation part as described below): few claims got paid and few denied as ," Medical record does not support the code billed"


My question:
Has anyone faced the same?
Any suggestions on the documentation of the moderate sedation to share it with our Cardiologist?


Type of Anesthesia
Moderate sedation
Estimated Blood Loss
Less than 20 cc
Complications
None
Operative Procedure
After informed consent the patient was brought into the Cath Lab and draped and prepped in the usual sterile manner. 2 mg of Versed and
25 of fentanyl was administered preoperatively and additional sedation was given throughout the procedure as needed for comfort. Local
Xylocaine was used to infiltrate the skin underneath the left clavicle.......

Follow-up will be in 1 week in Dr. xxx office.
Total sedation time was 37 minutes

Any suggestions would be helpful.
TIA.
 
Hi Jim,
Thanks for your response.
I am not exactly sure....
But I think our cardiologist gives the initial sedation and starts the procedure. Then it is monitored throughout by a nurse under his supervision....
I have emailed our doctor on this.

But, what additional documentation would you add on the moderate sedation?
Can you help with the exact wordings they look for?
 
Here is the moderate sedation statement that our cardiologists are using: "I was present in the room when moderate sedation was initially administered to the patient at and my face-to-face contact with the patient continued until ________. The trained nursing staff that monitored the patient and administered the medication have been documented in the procedure log as have the pre and post-procedure activities, please see that separate report for details. Also recorded in the case log are the total amounts and routes of the sedation medications used for this patient. The patient’s vital signs, level of consciousness, neurological, cardiovascular, and pulmonary status at the conclusion of the procedure were _________."
 
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