Wiki GD modifier for bypassing MUE's

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ollielooya

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Hmmmmm, found this MCR modifier and am tempted to use it. I am fully aware of what the NCCI policy statement has to say concerning the MUE'S, but this is a specific modifier used to "over-ride" the edits IF the situation is medically necessary, so not a violation of the policy to do so.

GD: Units of service exceeds medically unlikely edit value and represents reasonable and necessary services. Currently only CMS is using medically unlikely edits. Medically unlikely edits are not released by CMS nor commercially available. The provider documentation must support the medical necessity of exceeding the MUE (extracted from Understanding Modifiers 2010 from Ingenix).

I find this very interesting. Noticed National Government Services do not have this modifier included in their list at their website. I put in this question to another forum I frequent and received limited response. How about this forum? Anyone actually use this with success? Better yet, have others even heard or known about this one?
 
Colleagues, I'm starting to get used to answering my own posts, especially when no one else jumps in. For the sake of the AAPC members, I did further research with NGS MCR and discovered they do not recognize this code to over-ride the NCCI edits when appropriate regarding the MUE's. I was disappointed to learn of this, because it appeared to be a way out. The effort to make this a viable modifier seems to have died somewhere. Hope it makes it way back to being acknowledged by CMS, as it appears to have been in the works since 2008 (?)!
 
GD modifier

Thank you for posting your follow-up on your research on this modifier. I was just looking into the same question this AM. You saved me a step.
 
Was pleasantly surprised when I saw this old thread of mine resurface, as my research was put on permanent hold after coming to a dead-end. Am thankful that I was able to save you a step. Others have done that for me on here RE other pursuits I have had and it's nice to be able to return the favor. Thanks for your post!
 
CMS FAQ re excess units

I found this on the CMS website in reply to the question How do I report medically reasonable and necessary units of service in excess of a Medically Unlikely Edit?

For Medically Unlikely Edits (MUEs) that are adjudicated as claim line edits, each line of a claim is adjudicated separately against the MUE value for the code on that line. The appropriate use of Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) modifiers to report the same code on separate lines of a claim will enable a provider/supplier to report medically reasonable and necessary units of service in excess of an MUE value. CPT modifiers such as 76 (repeat procedure by same physician), 77 (repeat procedure by another physician), anatomic modifiers (e.g., RT, LT, F1, F2), 91 (repeat clinical diagnostic laboratory test), and 59 (distinct procedural service) will accomplish this purpose. Modifier 59 may be utilized only if no other appropriate modifier describes the service. For MUEs that are adjudicated as date of service edits, units of service (UOS) in excess of the MUE value may be paid during the appeal process. (See separate FAQ for information about date of service MUEs.)
(FAQ11352)

It does seem odd that modifier GD is there for this very reason but not utilized.
 
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