Wiki Does anyone have access to CPT Assistant?

[ThomasGolden]

What does CPT Assistant (Jun 96:6, Dec 05:3, Aug 09:3, Jun 12:16, Jun 13:14, Jan 14:10) say about ABI? CPT states that this code can be billed with a modifier 59 on the additional level. But Medicare has a MUE of 1. I am doing some auditing and the MUE's typically make sense but this one is throwing me off. Any suggestions on why this would be MUE of 1 when CPT states to use -59 on the additional level?

 

[CodingKing]

The information about why its a 1 is from the NCCI manual is as follows:

16. CPT codes 93922 and 93923 describe bilateral noninvasive physiologic studies of the upper or lower extremities. The MUE value for each of these codes is one (1) since it is unlikely that this testing would be performed on both the upper and lower extremities on the same date of service. In the unusual situation where testing on both the upper and lower extremities are performed on the same date of service, the appropriate code may be reported on two lines of a claim each with one (1) UOS and modifier 59 appended to the code on one of the claim lines.

So it sounds if this is one of those rare cases when upper and lower are both done that you would need to submit notes for review. Since MUEs don't seem to commonly end up in the NCCI manual my thought is CMS had problems with people using 2 units to indicate bilateral so they implemented the MUE to stop incorrect submissions.

 

[ThomasGolden]

Thanks!

Thank you CodingKing. I am thinking that I am going to suggest they use 93922 in conjunction with 93925 when they are doing both levels. That is actually a logical thought.