Outpatient Facility Coding Alert
Know How MUEs Can Affect Bilateral Billing
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Question: Why might I be receiving a denial for frequency when submitting two units of 30140 with modifiers LT and RT to Medicare? Tennessee Subscriber Answer: The bilateral surgery indicator of “1” indicates you can bill 30140 (Submucous resection inferior turbinate, partial or complete, any method) as a bilateral procedure. In this scenario, the obvious culprit may refer back to the code’s medically unlikely edits (MUEs). You’ll see that 30140 has an MUE of 1, which means that only one unit of 30140 may be submitted to the payer on a given date of service (DOS). A submission of 30140 on separate lines with modifiers LT (Left Side) and RT (Right Side) will result in a flag in the Medicare system for invalid CPT® code frequency. To override this denial, you’ve got to make sure to submit the claim as one unit with modifier 50 (Bilateral Procedure), instead.
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