Question Mixed Meal Test - CPT codes will exceed MUE

CXZook

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We have a physician that wants to start ordering a mixed meal test. Process will be to draw the following labs every 30 minutes for 5 hours glucose, BMP, Insulin, Proinsulin, C-Peptide, and Beta- Hydroxybutyrate every 30 minutes. Is anyone else performing these? Do you bill the test with the following Glucose 82951 and 82952 x 7, BMP 80048 x10, Insulin 83525 x10, Proinsulin 84206 x10, C-peptide 84681 x10, and Beta- hydroxybutyrate 82010 x10. If you perform this, how do you handle MUE denials?
 
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danachock

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Hi CXZook,
No, I apologize I do not bill any mixed meal tests. I may be able to offer some advice how I handle MUE's denials if that helps you.
I will try to break it down by insurance but I know I do not always follow these rules when we are close to timely.

Commercial -
If you receive a denial that you have exceeded MUE (denial states something that you have exceeded allowed units/service per a DOS) - I just instruct my biller something in this type of scenario - 1st) you give your biller your professional findings after your exhaustive review; 2nd) you explain what needs to be done such as appeal or send notes 3) TELL THEM what we are sending to support all those charges being billed 4th) where is that information located?

I'll make up a fictious scenario for you. Let's say we were denied for 80048 for exceeding MUE 2 with MAI 3 billing quantity 10 for that DOS. I'd first explain after reviewing the EOB with my reply to the biller - we exceeded the MUE of 2, billing 10 units and need to send the documentation to support billing these charges. Would you please send the laboratory test "Mixed Meal Test" performed on 04/29/2024 from the laboratory tab in Epic to support billing all these charges. Be precise and state what needs to be done to remedy this scenario okay.

Government -
I have seen various scenarios on this.
1st) It is the same scenario as above for commercial
2nd) Bill one unit one line one and second unit you roll up the remaining charges so it's 80048x1 with 80048x9 - follow above scenario
3rd) You bill quantity 2 on one line and the remaining 8 charges on another line for MUE - still follow the rules I displayed above please

Please be super cognizant, I am telling you to not just send a note to your biller without an explanation to appeal with notes. I have had too many conversations with my billing colleagues to know that they need to know what to do. They are not a coder. When you state appeal with notes; which notes is immediately in their mind. No kidding.
Again, please keep things simple. Even an experienced biller may not need all the details, but lets thoughtfully think of those that may be new and not acclimated on what needs to be done and possibly needs direction for assistance. We are in this MUE denial together.

Thank you for reaching out and I am hopeful I have helped with your MUE issue. If you have any additional questions/concerns please reach out.
Have a wonderful evening,
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT
 

CXZook

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@danachock the information you have shared on how to handle the MUE denials is perfect and extremely helpful! I appreciate all of the information and the scenario you shared to help me understand. I was actually look forward to a response from you because your wealth of knowledge is admirable, always look forward to reading your responses.
 

danachock

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Hi CXZook, you are so welcome. I am clearly embarrassed but am so appreciative that you believe my pathology coding intel is helpful.
Again thank you for your kind words, please reach out if you need help again okay!
Have a fantastic evening,
Dana
 
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