ASGE members may submit coding inquiries electronically to codingquestions@asge.org. When submitting a question, please allow at least three business days for a response. When submitting inquiries, please include the ASGE member’s name and ID number. Only questions will be accepted and not reports. Below is our featured Coding Question of the Month that could be beneficial to your practice.
Question:
We have been struggling with denials from multiple payers for Code 99223. The code was chosen for presenting a problem of high medical decision making and high risk (major procedure with risk factors). It was denied AFTER review of the consultation. How can we appeal the decision?
Answer:
Dispute using the AMA guidelines for risk, Surgery—Elective or Emergency:
"Elective procedures and emergent or urgent procedures describe the timing of a procedure when the timing is related to the patient’s condition. An elective procedure is typically planned in advance (e.g., scheduled for weeks later), while an emergent procedure is typically performed immediately or with minimal delay to allow for patient stabilization. Both elective and emergent procedures may be minor or major procedures."