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Coding Q&A

Posted By Mary L. Nations, Thursday, April 13, 2017

Original Coding Alert from 12/27/2016 is attached for reference.


In regard to the Coding Alert from 12/27/16 on moderate sedation claims, can you tell me if this has been corrected and if I should go ahead and rebill or appeal these sedation codes? I called Medicare today (4/12) and they didn’t seem to know anything about this. 


A:  The new NCCI procedure to procedure edits did come out April 1 so it makes sense to resubmit claims, though carriers sometimes lag behind. Apparently, some intermediaries have been able to make corrections internally and are paying the codes for sedations.  Other intermediaries are not able to make the corrections internally and are having to wait until Medicare makes them.   For this reason, some are now paying and some are not.  Probably will be some variability in local carriers for a while.



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Tags:  Coding 

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