tci ED Coding & Reimbursement Alert - 2002 Issue 11

READER QUESTION: Conscious Sedation Denial

Question: I submitted a claim for a shoulder dislocation using codes 23650 (Closed treatment of shoulder dislocation, with manipulation; without anesthesia) appended with modifier -54 (Surgical care only) and 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation). The denied claim's EOB states that shoulder dislocation fees include conscious sedation. But other insurers have not denied these claims. What should I do? North Carolina SubscriberAnswer: You should consult your practice's contract with the carrier. Check the coding set that was mutually agreed upon to make sure your carrier's denial passes muster. The "included service" note on...

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