It is very likely that the insurance is going to deny the second D9222 and D9223. I would submit medical records indicating the need for general anesthesia the second time (twice in a day). This is a rare occurrence, and it's likely that it will be denied as you already had the patient sedated once during the day and should have billed additional anesthesia time with D9223. Submitting the medical records with the claim should help the payer understand the need - and if not, you may want to submit an appeal, if the claim is denied.

D9222
deep sedation/general anesthesia - first 15 minutes; Anesthesia time begins when the doctor administering the anesthetic agent initiates the appropriate anesthesia and non-invasive monitoring protocol and remains in continuous attendance of the patient. Anesthesia services are considered completed when the patient may be safely left under the observation of trained personnel and the doctor may safely leave the room to attend to other patients or duties.