Wiki MUE 88341 CO151 Denials...

[Whidbey]

Hello,

Have any of you experienced an MUE CO151 (mainly Medicare) denial for >12 units of 88341? If so, have appeals with supportive medical necessity documentation over turned the denials? Any tips to overcome these denials in addition to remaining under the MUE 12 units of 88341? Thank you in advance!!

 

[danachock]

Hi Whidbey,
The MUE for 88341 for CMS is 13 units for a DOS (day of service). Anyone can jump in here and tell me I'm not correct here, but you roll up the charges on a "lymphoma work up" billing 88307 for the freshly received specimen with 88342x1 and 88341x20 (off the top of my head for this exercise please). Let's follow CMS rules - you bill 88341x13 units on one line and you bill 88341x7 for subsequent line with 7 units with XS modifier. It won't really matter for the Medicare they will bundle it all within "maximum amount allowed". BUT, with commercial it may differ, do not be afraid to appeal one of these with the with notes. I'll do it all day long here.
Thank you for listening and have a wonderful evening,
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT