martinni1974
Guru
What Are MUE's Anyway.....
The Medically Unlikely Edits (MUEs) were developed by the Centers of Medicare and Medicaid (CMS) to prevent inappropriate payment of services that should not be reported for multiple units for the same date of service. The MUEs reflect the maximum number of units of service that a provider might report under most circumstances for the same HCPCS/CPT code, for the same beneficiary, on the same date of service.
We recieve many claims everyday that deny for this reason. Here is an example below:
CPT code 59425 is defined as, "antepartum care only; 4-6 visits". This code is already valued for 4-6 visits. Many providers append multiple units to this code despite the fact that the code definition and RVU already reimburses for the number of visits in the code definition. Editing software will pick up this discrepency and cause your claim to deny.
When appealing make sure to read the full code definition in the year CPT book that correlates to your date of service as well as verify the MUEs. If you find yourself in a quandry take a look again at your documentation and how it matches up to your coding.
You may have chosen a wrong CPT or have a typo in the units field on your HCFA.
Happy Appealing
The Medically Unlikely Edits (MUEs) were developed by the Centers of Medicare and Medicaid (CMS) to prevent inappropriate payment of services that should not be reported for multiple units for the same date of service. The MUEs reflect the maximum number of units of service that a provider might report under most circumstances for the same HCPCS/CPT code, for the same beneficiary, on the same date of service.
We recieve many claims everyday that deny for this reason. Here is an example below:
CPT code 59425 is defined as, "antepartum care only; 4-6 visits". This code is already valued for 4-6 visits. Many providers append multiple units to this code despite the fact that the code definition and RVU already reimburses for the number of visits in the code definition. Editing software will pick up this discrepency and cause your claim to deny.
When appealing make sure to read the full code definition in the year CPT book that correlates to your date of service as well as verify the MUEs. If you find yourself in a quandry take a look again at your documentation and how it matches up to your coding.
You may have chosen a wrong CPT or have a typo in the units field on your HCFA.
Happy Appealing