Wiki Coding with 95076 & 95079

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mmart1223

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Hello,

We've recently acquired a provider who will be performing OIT on our patients. This is new to us and we're still working on how to properly code and bill for this. We received a denial for OIT from Cigna by billing 95076 x 1 and 95079 x3 with Cigna adjusting off 1 unit as "exceeds maximum allowable".

When I called on this, the rep. told me that only 2 units of 95079 are allowed.

Is this because after 4 hours, we're to bill an E/M? or is there some sort of unit limitation? Or are we just billing incorrectly all together?

Thank you in advance!
Maggie
 
Marissa Padworny

Hello,

We've recently acquired a provider who will be performing OIT on our patients. This is new to us and we're still working on how to properly code and bill for this. We received a denial for OIT from Cigna by billing 95076 x 1 and 95079 x3 with Cigna adjusting off 1 unit as "exceeds maximum allowable".

When I called on this, the rep. told me that only 2 units of 95079 are allowed.

Is this because after 4 hours, we're to bill an E/M? or is there some sort of unit limitation? Or are we just billing incorrectly all together?

Thank you in advance! Code
Maggie[/QUOTE]

Hi Maggie,
What you have come across is an edit from CMS medically unlikely edits code. MUE's are determined to be the max amount of units per date of service billed for a specific code. CMS considers more than 2 units medically unnecessary for 95076. Here is a link to all the MUE's.

https://www.cms.gov/apps/ama/licens.../2017-04-01-MCR-MUE-Practitioner-Services.zip


Hope that helps you!
Marissa Padworny CPC
AAPC ICD10 Proficient
AAPC 2017 MACRA Proficient
 
Awesome thank you!

So with this new information, we billed correctly with the 3 units of 95079 however due to MUE, 1 of the 3 units denied is a valid adjustment?
 
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