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aleigh

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Hi,
We are getting a lot of denials when we bill for multiple units of 88374. We are billing over the MUE of one, but it states to report for each unduplicated multiplex probe stain procedure per specimen. We will bill one unit, and then bill the additional units on another line with a XU modifier. Has anyone appealed these to Medicare? I have appealed even with documentation and nothing. I am getting a little frustrated, we bill a lot of these and appealing is timely...especially when the time spent does nothing. I'd appreciate any insight!
Thanks
 
88374

Hi Aleigh;
From my denial experience in the path or even lab world - if you have reached the MUE with Medicare - you will need to appeal. Personally I would bill these out using a 59 modifier. I would also add a comment on each procedure line adding the description - showing that each charge is separate from the next and why. Tested for xxxx and Tested for yyyy and Tested for zzzz.
When you appeal - is your pathology report complete? Does it state that this and that was done? Your pathology report is VERY important and needs to reflect the charges that are billed. If it doesn't, don't be afraid to reach out to your pathology department immediately (while you are billing the claim) to be more descriptive. They really like to get paid for the services they have done.
Hoping this may help,
Dana Chock, CPC, CCA, CPMA, CHONC, CPMA, CPB
Anesthesia, Pathology, & Laboratory Coder
 
had the same problem with MUE on another code, was told by medicare to continue to use the 59 modifier for same codes (i.e duplicates or MUE) and the the "X" modifiers do not apply to MUE...try the 59 and see where you get..
 
59 is what I originally billed with, and still denied.
I will try the appeal, was hoping to avoid that, but looks like I won't be able to.
Thanks for the input.
 
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