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  #1  
Old 01-25-2013, 02:59 PM
mcamp mcamp is offline
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Default Denial for multiple units

Please help!
I work for a Gastroenterologist who recently performed a follow up colonoscopy on an est.
pt with a 10 year history of ulcerative colitis. The physician removed a 3 mm polyp with cold biopsy forceps in the sigmoid colon. He also obtained biopsies every 10 cm due to the patients long history of ulcerative colitis. The charge was 88305 x 13 units and 88312 x1 unit. Medicare paid for the 88312 and denied 88305.
I have tried to find the actual policy regarding maximum unit edits and have unable to find it. I want to make sure I use modifier 59 correctly. I would appreciate any help I can get.
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Old 01-28-2013, 07:53 PM
bbooks bbooks is offline
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Medicare denied all 13 of the 88035? Did you use modifier 59 on any of these codes?
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Old 01-29-2013, 06:05 AM
bridgettemartin bridgettemartin is offline
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Check with your MAC. We are in Indiana, and the max units per line item is 5. We have been instructed to use modifier 76 on subsequent line items. I can't say that I have had 13 units, though. I don't know if there is a max number of units allowed total or not.
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Old 01-29-2013, 09:25 AM
mcamp mcamp is offline
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Yes the did deny all 13 units of 88305. I did not use modifier 59 at all.
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Old 01-29-2013, 02:06 PM
prmcfall prmcfall is offline
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I have some documentation that I have obtained from the CMS website that discusses how to bill this. I'd be happy to help you if you want to contact me. I do billing for a pathology lab and we bill multiple units quite a bit. I can help you find the information about the numbers allowed and where the new manuals are located. Try this link first if it doesn't help let me know.
http://www.cms.gov/Regulations-and-G...CMS018912.html
from there go to Chapter 16. I also have a copy of the Correct Coding Edits information for this year as well that I'd be happy to send you a copy of the section you need.
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Old 02-05-2013, 10:58 AM
mcamp mcamp is offline
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Thank you so much for the info!
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Old 03-18-2013, 10:54 AM
codegirl2012 codegirl2012 is offline
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Medicare has not published MUE ( Medically Unlikely Edits) for 88305 yet. We bill out multiple units of 88305 too, I add modifier .59 in units more than 7.
so if youbilled 13 units, I wiolu definately add .59 on the last 6 .

Hope this helps!
Codegirl
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Old 03-18-2013, 10:56 AM
codegirl2012 codegirl2012 is offline
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sorry for the typo............its Monday morning !!!
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