Wiki 87798 Billing Multiple Units

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Has anyone had to bill 87798 with multiple units to First Coast / Medicare Mac, for a clinical laboratory, POS 81.

When billing to the Palmeto / Medicare Mac, you can put up to 13 units on one line, with no modifier, and all units pay.

First Coast rejects the claim, stating there are billing submission errors. We have tried using modifier 91 and 59, but they only pay for one unit and deny the rest as a duplicate.

Any insight would be greatly appreciated.

Thank you.
 
We are seeing the same issue with Noridian our MAC, we are still investigating the issue, will post when we know more. But we are submitting the one line 87798 with the 13 units per the MUE guidelines.
 
Any updates on your efforts with Noridian? We are just starting to bill multiple units of 87798 and I'm wondering what to expect. Thanks!
 
I was wondering are you billing 87798 instead of 87505-87507? Or, what is your opinion on billing 87798 if we are only looking for ONE organism that's offered in 87505-87507?
 
Units

The carrier just needs clinical data to verify medical necessity for all of the units. The MAI on the MUEs is a "3" meaning its a clinical data denial. These claims will deny with multiple units as duplicate. Documentation just needs to be submitted.
 
Hi @haraml7 We are billing 87798*13 with 90 and XU modifier in13 individual line items, can you please advise how we can avoid duplicate denial and which is the appropriate modifier to get these denials resolved.

POS: 81
Case type: UTI
Medicare MAC : Firstcoast
 
Hi @haraml7 We are billing 87798*13 with 90 and XU modifier in13 individual line items, can you please advise how we can avoid duplicate denial and which is the appropriate modifier to get these denials resolved.

POS: 81
Case type: UTI
Medicare MAC : Firstcoast
You cannot bypass this, if this is the procedure performed you bill for it and send documentation. Adding a modifier to bypass an edit is not good practice. If medicare wants to see documentation you would need to send documentation. The MUEs come from CMS, which all MAC carriers follow, i am not sure why firstcoast is denying because the MUEs specifically state 13 units can be billed. What if you put it on one line, with 13 units, instead of individually seperating them?
 
Good morning,
Our clinics have several in house panels. I have a claim on which we performed three separate panels (STI, Women's Health and Wound) there are a few targets that overlap. We bill CPT 87798 with multiple units appropriate for each panel. When we have multiple panels on one claim is it appropriate to remove a unit per each target that overlaps panels and then bill individual lines for 87798 with the appropriate number of units with modifier 59 attached? The MUE for 87798 is 13 so I cannot bill all on one line. My lines would like this for 87798:
  • 87798-59 - units 12 (Wound Panel)
  • 87798-59 - units 9 (Women's Panel)
  • 87798-59 - units 2 (STI Panel)
Or, is the appropriate method to only bill for the panel with the highest number of targets? In this case, the Wound Panel. The information from AAPC below reads a little vague to me. Especially since these are targets with no unique CPTs:

A laboratory panel is a package of tests that often are ordered together. Each panel code (80047-80076) includes multiple tests. When all the tests included in the panel are ordered, report the panel code. If any test defined as part of the panel is not performed, report the code(s) to describe the individual tests performed. CPT® instructs:
…panels were developed for coding purposes only and should not be interpreted as clinical parameters. The test are listed with each panel identify the defined components of the panel. These panel components are not intended to limit the performance of other test. If one performs tests in addition to those specifically indicated for a particular panel, those tests should be reported separately in addition to the panel code
Do report two or more panel codes that include any of the same component test. If the tests included in two panels overlap, report only the panel code that includes the greater number of test to meet the code definition. Tests not part of the panel may be separately reported.


From <https://www.aapc.com/blog/39474-cpt-coding-laboratory-panels/>

I appreciate the guidance. Thank you.
 
Hello! How can we bill 87798 (25x)? Do I need to separate the test and add mod 59?
Is there any update in MUE this year? Is laboratory part of the Outpatient Hospital Services MUE?
 
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