Wiki J9045 MUE Edit: 2040

[lzebro@krmc.org]

I am getting Edit 2040- Medicare FAC MUE - HCPCS total units exceed daily allowed Medically Unlikely Edit maximum 22 based on clinical benchmarks (LID) when coding J9045 - Is there a modifier I need to be coding with this? I have verified the provider's orders with pharmacy's dosing - everything is correct - Thoughts? thank you - Lois

 

[CBLENNIE]

Since J9045 is for 50 mgs of carboplatin and the MUE units is 22 per date of service (DOS) that is a maximum dosage per DOS of 1100 mg. If your provider plans to administer more than the 1100 mg to a patient during a single infusion session on a single DOS you would be best served by trying to get a prior authorization for the dosage listed in the physician's treatment plan.

If obtaining a prior authorization is not an option and the provider proceeds with the treatment plan and administers more than the 1100 mg of carboplatin, then you are likely to be denied for the excess units and you can try and appeal it.