Cardiology Coding Alert

Brush up on the difference between line item and date of service MUEs.

Starting July 1, 2016, medically unlikely edits (MUEs) for percutaneous coronary services underwent two major changes:

1. The number associated with each MUE changed
2. The nature of the edits changed from line edits to date of service edits.

Before you code your next coronary intervention, be sure you’ve reviewed and understand these MUE updates.

Check DOS Total, Not Just Units per Line

CMS uses line edits and date of service edits for MUEs. The edits we’re discussing changed from line edits to date of service edits starting July 1.

Line edits: For line edit MUEs, Medicare checks each line of a claim against the MUE value for the code.

Example: Before July 1, 92920 (Percutaneous transluminal coronary angioplasty; single major coronary artery or branch) had a line edit MUE of 1. So if you reported two units on a single line for your physician, Medicare would deny that line, and you could appeal the denial.

However, if you reported each unit on a separate line with an appropriate modifier, such as 92920-LC (Left circumflex coronary artery) on one line and 92920-LD (Left anterior descending coronary artery) on another line, your claim would not trigger an MUE denial.

Date of service edits: In April 2013, CMS added date of service edits to the MUE mix. For these types of edits, Medicare adds together the units for all claim lines that use the same CPT^® or HCPCS code and compares the total for the date of service to the MUE.

Example: Starting July 1, 92920 has a date of service MUE of 3. So if you report more than three units total, expect to appeal to claim payment for all medically necessary services, even if you report each unit on a separate line, as in the sample below:

• 92920-LC
• 92920-LD
• 92920-LM (Left main coronary artery)
• 92920-RC (Right coronary artery).

Plan to Appeal If You Exceed These Tallies

Below you’ll find the list of codes with MUE changes. The final column shows the MUE value effective July 1, 2016. The good news is that if you use the initial major artery code correctly, you’re unlikely to exceed MUEs during a session. Performing interventions on three major arteries at the same session is fairly rare.

Resource: You can download and view MUEs at www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html.