Wiki Billing bilateral ultra-sound 76942

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ollielooya

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Regarding patients who receive bilateral injections with US guidance for a rheumatology specialist: NCCI edits allow one per encounter per the MUE's. I've touched on this question before in the past, but must follow thru again. It still is my understanding that these edits CAN be overridden if warranted by medical necessity and that dr. can bill for RT and LT. One unit will pay and for the other to pay it will require going thru the appeal process with Medicare. The physician would like to know if he should bill out for the 2 units or just leave it at one? Have any of you successfully over-ridden the edits? Just not comfortable advising yet so once again enlisting the support of colleagues here on the forum...
 
OCD, you came to the rescue again!
Thank you for your clear and definitive response. I am aware of the NCCI edits and the only reason we were thinking of moving beyond the MUE edits was due to medical necessity and being told by CSR that an appeal might generate a reconsideration to over-ride in a case by case scenario. We had considered modifier GD which over-rides the MUE's, but alas, it is not recognized by our MAC. This is why I am once again reaching out to my colleagues. Thank you for taking YOUR time to answer my post. I always read your replies with great interest!
 
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