Pathology/Lab Coding Alert

Question: How should we code a claim when the units performed exceed the Medicare MUE?Arkansas SubscriberAnswer: You can override medically unlikely edit (MUE) limits by using specific modifiers when you can document medical necessity for the service.For instance: If the pathologist evaluates two flow cytometry panels for two distinct medical conditions for the same patient on the same day, one with 2 markers and one with 8 markers, you should report two units of 88187 (Flow cytometry, interpretation; 2 to 8 markers) for the pathologist's interpretation. Because CMS assigns an MUE of "1" to 88187, you'll need to use a modifier to override the MUE.Do this: Report 88187 on one claim line and 88187-59 (Distinct procedural service) on a separate claim line.Other modifier options: Medicare's MUE frequently asked questions # 8736 states that "Since each line of a claim is adjudicated separately against the MUE of the code on that [...]