Wiki DENIALS for 82542

[niecey50]

Is anyone having the problems of denials for 82542> This lab code does not have an MUE but Medicare has denied claims billed with more than 6 units. I have a problem with this because there is no MUE for this code. This just started happening.

 

[phammers66]

82542 denials

It started happening to us too here recently. I spoke to a rep and explained that the code was not listed on the MUE list and she told me that they do not have to tell physicians how many units they are looking for. She reviewed the code herself and then sent it up to a "Senior" for review.

I called back today and found that the Senior had told her that the amount we were billing was not over the MUE and just to appeal the claim.

The only problem is that we have several (over 1000) claims that would need to be appealed because Medicare is incorrectly denying them.

This to me is uncalled for. If the denial is in error then they should fix their system instead of putting the providers through the appeal process.

I am waiting for the Senior to call me back.