MedicaidBilling CodesHigh impact
Attention All Providers: Claims for Evaluation & Management (E&M) Services with a Diagnosis Code Related to Surgical Procedures Will Deny
Nevada Medicaid·NV·Provider Announcement
Effective date
Sep 3, 2024
We identified it
Jun 21, 2026
Summary
Nevada Medicaid will deny E&M service claims when billed with diagnosis codes related to surgical procedures during pre- or post-operative periods, even if the E&M service is unrelated to the surgery. Claims will be denied with error code 7220, and providers will not receive reimbursement for these E&M services.
Action Required
Immediately: Billing team must review all E&M claims for Nevada Medicaid patients to ensure diagnosis codes used are unrelated to any surgical procedures during pre- or post-operative periods. Update billing workflows to verify diagnosis pointer alignment before claim submission. Train staff to identify surgical-related diagnosis codes and use only diagnosis codes that match the actual reason for the E&M visit. Failure to comply will result in claim denials with error code 7220.