Is the EM code being submitted with separate dx's then what is being diagnosed on surgical CPT code? If not, and unless the tx note you submit really shows that the EM was above and beyond the portion of the EM code already factored into the surgical code, you will be out of luck.
If you are using separate dx's(because it is warranted, not just to get paid), and the EM is truly separately identifiable by the tx note, you will have to continue to appeal the denials, if the insurance company has put an edit into place automatically denying EM's submitted with surgical codes, while trying to appeal to them about the edit. Twice, with different insurance companies, I have run into this issue. The first one(Aetna), after complaining constantly to them, and sending evidence as to why their edit was wrong, changed their edit(they had numerous providers complaining, not just us). The second one(Humana), they absolutely refused to listen to reason, so we dropped that plan. It was costing us more time to do the appeals then they would pay us for the EM code, when we would finally win the appeal.
Medicaid plans are awful to deal with, so I wish you luck!