Question: New York Subscriber Answer: One key to the denial might be found in the lack of coding for the patient's condition. Your diagnosis code should indicate the co-existing medical condition that justifies your anesthesiologist's involvement in the case, not the gastrointestinal condition leading to the endoscopy. You may want to consult with your anesthesiologist to verify that the patient had a condition such as: • Parkinson's disease (332.0) • Heart conditions (such as 410.xx, Acute myocardial infarction or 427.41, Ventricular fibrillation) • Mental retardation (318.x) • Seizure disorders (such as 780.39, Other convulsions) • Anxiety (such as 300.0x, Anxiety states) • Pregnancy • History of drug or alcohol abuse. These are just some of the conditions that payers may require to justify the presence of an anesthesiologist at a colonoscopy. ICD-9 2010 also has two codes to describe failed sedation attempts: 995.24 (Failed moderate sedation during procedure) and V15.80 (Personal history of failed moderate sedation). If your anesthesiologist's documentation confirms one of these conditions, 995.24 or V15.80 would also justify an anesthesiologist's involvement to most payers. The conditions listed above constitute the medical necessity of anesthesia with the procedure. If you used a screening diagnosis or treatment of commonly found conditions instead of the clinical condition requiring anesthesia, payers will not pay you for these services. Also note the number of other possible elements that may need to be met for proper reimbursement of EGD anesthesia, including documentation noting the patient's physical status. For example, some payers require a physical status modifier of P3 (A patient with severe systemic disease) or higher. Caution: Good news: