Oncology & Hematology Coding Alert

Question: Why did we get a denial from Medicare for 4 units of +96367?New Mexico SubscriberAnswer: The culprit is probably a Medically Unlikely Edit (MUE) of 3 for +96367 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional sequential infusion of a new drug / substance, up to 1 hour [List separately in addition to code for primary procedure]).CMS states that MUEs reflect the maximum number of units the vast majority of properly reported claims for a particular code would have, so you shouldn't need to override them often. But you can override an MUE when your physician performs and documents a medically necessary number of services that exceed the limit.To override the MUE (when you are absolutely positive your documentation of orders, times, medical necessity, and everything else will support all the units you want to report), you may submit +96367 x 3 on one line [...]